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La technique des implants sur mesure 3D en élastomère de silicone, permet à partir d'un scanner de combler avec précision, une malformation thoracique congénitale, qu'elle soit osseuse (pectus excavatum) ou musculaire (Syndrome de Poland) avec pour conséquence un repositionnement naturel des seins. Nous rapportons notre expérience de 25 ans chez 301 femmes (234 Pectus et 64 Poland). La correction pariétale doit être faite en première intention. Il est fréquent de devoir réaliser dans un second temps chez la femme, une plastie mammaire complémentaire notamment en présence d'une insuffisance de volume glandulaire ou d'un sein tubéreux assez fréquemment associé. Computer-aided design and manufacturing of custom-made elastomer implants leads from a CT scan to fill in with precision, a congenital chest wall congenital deformity, both bone (pectus excavatum) and muscle (Poland Syndrome), resulting in a natural repositioning of the breasts. We report our 25 years' experience in 301 women (234 Pectus + 64 Poland). Parietal correction must always be done in first intention. It is common to have to carry out a second stage in women with an additional mammaplasty especially in the presence of insufficient glandular volume or a fairly frequently associated tuberous breast. [ABSTRACT FROM AUTHOR]

Le pectus excavatum est la malformation thoracique congénitale la plus fréquente puisqu'elle affecte une personne sur 500. De nombreuses techniques chirurgicales ont été proposées : certaines peuvent être suivies de complications ou de résultats insuffisants alors même que leur utilité fonctionnelle est très controversée. Une chirurgie secondaire utilisant un implant 3D profond sur mesure, peut être une solution élégante, efficace et sûre comparée aux autres. Elle permet d'obtenir le bon résultat esthétique espéré par les patients exempts de tout contexte respiratoire ou cardio-vasculaire. Most common congenital malformation of the thorax, Pectus Excavatum affects about one in 500 people. Several surgical or medical techniques have been proposed. Some are followed by complications or insufficient results even though their constant functional value is highly controversial. Secondary surgery with a deep customized 3D elastomer implant, may be an elegant effective and safe solution compared to others; it allows a good aesthetic result expected by patients in the absence of any respiratory or cardio-vascular functional context. [ABSTRACT FROM AUTHOR]

Le pectus excavatum affecte environ une personne sur 500 : c'est la malformation du thorax la plus fréquente. Plusieurs techniques chirurgicales ou médicales ont été proposées. Certaines peuvent entraîner des complications ou des résultats insuffisants. La chirurgie secondaire du pectus excavatum par implants profonds sur mesure 3D est une solution élégante et efficace. Elle permet d'obtenir le bon résultat esthétique attendu par les patients en l'absence de contexte fonctionnel respiratoire ou cardiovasculaire. The pectus excavatum affects about one in 500 people. It is the most common malformation of the thorax. Several surgical or medical techniques have been proposed. Some are followed by complications or insufficient results. Secondary surgery with a deep customized 3D implant, may be an elegant and effective solution; it allows to obtain a good aesthetic result expected by patients in the absence of any respiratory or cardiovascular functional context. [ABSTRACT FROM AUTHOR]

The authors report a case of a patient managed for severe cranial vault depression following combined neurosurgery and radiotherapy. This situation caused major aesthetic discomfort and was potentially dangerous due to the mechanical weakness of the bone flap. The authors had a CAD (computer aided design) silicone elastomer custom-made implant made to fill perfectly the depression. Beforehand, an expansion was performed to cover the implant after removal of the radiated skin. The surgery and post-operative course raised no concerns. After one year of follow-up, the result is very good and the patient very satisfied, proving that this technique certainly has its place in the therapeutic arsenal when faced with a tissue defect of the cranial vault., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Pectus excavatum (PE) is the most common congenital chest wall deformity, whose cardiopulmonary consequences are controversial. PE surgery is in our experience usually performed for aesthetic reasons., Objectives: The aim of this study was to evaluate the impact of PE on respiratory function and exercise capacity in patients with PE before patient-specific silicone implant correction., Methods: This monocentric prospective study conducted at Toulouse University Hospital included sixty patients scheduled for custom-made silicone implants correction. Respiratory function (pulmonary function tests (FPTs)) and exercise capacity (VO 2 max) were measured before surgery., Results: Before surgery, no (0/60) restrictive lung disease was detected, with a mean total lung capacity (TLC) of 98.5% of predicted value (IC 95%; 80.4-137). Median VO 2 max (n=56) was normal (89% predicted), with no cardiac limitation., Conclusion: In this cohort, PE had no impact on respiratory function nor exercise capacity. In patients without cardiac or respiratory effects of PE, silicone implants should be considered the preferred approach as it adequately addressed patients' main complaint of low self-esteem., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objectives: Smoking patients undergoing a plastic surgery intervention are exposed to increased risk of perioperative and postoperative complications. It seemed useful to us to establish an update about the negative impact of smoking, especially on wound healing, and also about the indisputable benefits of quitting. We wish to propose a minimum time lapse of withdrawal in the preoperative and postoperative period in order to reduce the risks and maximize the results of the intervention., Methods: A literature review of documents from 1972 to 2014 was carried out by searching five different databases (Medline, PubMed Central, Cochrane library, Pascal and Web of Science)., Results: Cigarette smoke has a diffuse and multifactorial impact in the body. Hypoxia, tissue ischemia and immune disorders induced by tobacco consumption cause alterations of the healing process. Some of these effects are reversible by quitting. Data from the literature recommend a preoperative smoking cessation period lasting between 3 and 8 weeks and up until 4 weeks postoperatively. Use of nicotine replacement therapies doubles the abstinence rate in the short term. When a patient is heavily dependent, the surgeon should be helped by a tobacco specialist., Conclusions: Total smoking cessation of 4 weeks preoperatively and lasting until primary healing of the operative site (2 weeks) appears to optimize surgical conditions without heightening anesthetic risk. Tobacco withdrawal assistance, both human and drug-based, is highly recommended., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objectives: Tobacco addiction is a risk factor for complication in plastic surgery. The authors have assembled concrete arguments detailing the risks of perioperative and postoperative complication that are incurred by a patient with continued tobacco intoxication who wishes to undergo a surgical intervention., Research Strategy: Through application of the PRISMA criteria, we have carried out a systematic review of the literature, in which we explored five databases while using predefined keywords. We selected randomized, controlled observational studies on the perioperative and postoperative complications related to tobacco use in actively smoking, abstinent and non-smoking patients., Data Collection and Analysis: The levels of evidence for each article were evaluated. Risk of bias was assessed using the Newcastle-Ottawa Scale. Incidence parameters including the Odds Ratio and relative risk were calculated for each complication of which the number of occurrences had been indicated. Meta-analysis of the results was carried out., Results: We included 60 observational studies. In the cosmetic surgery group, we calculated a combined Odds Ratio of 2.3 [1.51-3.54] P<0.001 for surgical site infections and 2.5 [1.49-4.08] P<0.001 for delayed wound healing. In the bariatric surgery sequelae group, we found a combined Odds Ratio of 3.3 [1.90-5.64] P<0.001 with regard to delayed wound healing and 3.1 [1.39-7.13] P=0.006 for cutaneous necrosis. No proof was provided as to the possible influence of tobacco on the success rate of free flap microsurgery, but it is difficult to extrapolate results on the latter to digital reimplantation., Conclusions: The review underlines the fact that patients with smoking habits run a significantly heightened risk of cutaneous necrosis, particularly in the event of major detachment (cervico-facial lift, skin-sparing mastectomy, abdominoplasty), of additionally delayed wound healing and of addition surgical site infections. Rigorous preoperative evaluation of smokers could help to diminish these risks., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Poland's syndrome is a deformity of the breast and sometimes of the chest wall. Several techniques, which may be combined if necessary, are generally used to treat the forms involving both the breast and chest wall (breast implants, customised chest wall implants, latissimus dorsi pedicled flap). For some years, we have also grafted autologous fat cells according to Coleman's method to treat this rare disorder. We report the preliminary results of this technique and demonstrate its value in the treatment of Poland's syndrome. We studied patients treated for Poland's syndrome by autologous fat injection between 1 January 2003 and 31 December 2005. We recorded their age, gender, the other surgical techniques used, and grade of Poland's syndrome according to the classification of Foucras. Concerning fat injections, we recorded the number of sessions, volumes injected and complications. The series was composed of seven women and one man, mean age 25 years (range 13 to 40 years). Four patients were grade I, three were grade II and one grade III. The mean number of fat injection sessions was 2.1 (range 1-5) and mean volume injected 96 cc (range 25-200 cc). Lipofilling was used alone in one case and associated with other reconstruction techniques in seven. We had one complication, fat necrosis which progressed favourably after surgical drainage. Autologous fat injection appears to us to be a treatment which can be used alone, or more often associated with traditional reconstruction techniques in all grades of Poland's syndrome. This technique is useful to add volume and especially to correct the contour defects of this syndrome such as the subclavicular hollow and absence of anterior axillary fold.

A variety of breast deformities of differing appearances can be grouped together within an extensive syndrome that is characterized by anomalies of the breast base and preferentially involves the lower quadrants. Tuberous breasts are the most typical, but not the only, form of the deformity. The authors studied a series of 37 patients who had breast surgery, and they used a classification of three types: I, II, and III (in increasing order of severity). In type I breasts (minor form), only the lower medial quadrant is deficient; in type II breasts, both lower quadrants are deficient; and in type III breasts, all four quadrants are deficient. The study showed a predominance of minor forms (54 percent of breasts operated on) and of combinations including at least one minor form (81 percent of patients). Seventy percent of women had a breast asymmetry of more than 100 g. Only 27 percent of breasts operated on were hypotrophic, 45 percent were of normal volume, and 28 percent were hypertrophic. The authors propose a procedure to treat the minor forms of the deformity, using a mammaplasty with a superior pedicle and a lower lateral dermoglandular flap to fill the deficient lower medial quadrant. They define the indications of the classic techniques according to the type of deformity and stress the frequent need for secondary revision.

Objective: To compare various techniques for the treatment of pilonidal sinus., Design: Retrospective study, Setting: University Hospital of Toulouse, France., Subjects: 246 consecutive patients who presented between 1979 and 1996. The male:female ratio was 2:1, and the mean age 26 years (range 18-69)., Interventions: 218 one or two stage excision and rotation skin flaps, and 28 simple incisions., Results: 16 sinuses recurred, and no flaps necrosed., Conclusion: Excision and rotation skin flaps offers an effective and elegant alternative to the more classic operations for pilonidal sinus as it causes less postoperative pain and shortens convalescence.

The authors have presented a predetermined design of cutaneous resection for abdominoplasty without relocation of the umbilicus. The design is characterized by two lateral tips, pointing upward, and a central dome. The upper and lower edges of the cutaneous incision are of the same length, which prevents puckers and allows optimal evolution of the scar. The median cutaneous resection removes the horizontal base of the triangular area of pubic hair, producing a lower final scar and giving the mons pubis a more youthful appearance. The lateral cutaneous resections allow transverse redraping of the abdominal skin, and the oblique scars, placed in the natural folds, are easily concealed even under brief attire. Unlike individual resection techniques that require practice and experience, this technique is perfectly codified and can be carried out by less experienced surgeons.

The authors have carried out an experimental protocol on pigs, producing identical electrical burns to examine clinically and histologically the evolution of these burns with time. A clinical lesion in the form of a rosette was observed. It was composed of three zones: a central zone of carbonization, a pale ischemic intermediate zone, and an erythematous peripheral zone. Microscopic observation showed vascular thrombosis in the intermediate and peripheral zones in addition to necrosis of the central zone. These vascular lesions can be classified in three stages, I, II and III, according to the degree of vascular damage. The evolution of the lesions was stabilized at 72 hours after burn injury. These observations are important in determining the surgical treatment, particularly debridement, on postburn day 3, when the prognosis of the intermediate and peripheral zones must be taken into account.

The face is an area of great cosmetic importance where the repair of deep burns is particularly delicate, as both appearance and function must be taken into account. In order to improve the aesthetic prognosis of full skin thickness facial burns, a primary pressure graft technique was used in eight patients. Early excision was carried out during postburn day 3 and after good-quality granulation tissue was obtained around day 10, a full skin thickness graft was applied. Pressure was applied to the graft and maintained for 10 days. The grafts took successfully in all patients with very satisfactory cosmetic results. This is an original technique as it replaces burned tissue at a very early stage with tissue which is normal in thickness and quality.

The technique of argon laser treatment of port wine hemangiomas has been greatly improved since first used in the medical field. Complications may however occur and the authors report in this paper their experience and special studies performed on hyperpigmentation. This complication is due to an increase in melanic normal production as it has been proved by optical and electron microscope studies on pigmented skin biopsies.

Eleven cases are reported of island flaps containing only venous pedicles. All but two survived completely without arterial input and all the successful cases were on the extremities. The possible reasons for this are discussed.

The authors present two cases of extensive and very deep electrical burns of the skull, involving the dura and producing neurological complications. In both cases the surgical excision and repair was carried out in four stages. This paper sets out the clinical justification for this approach.

Using carbon dioxide laser, the authors proved the existence of a new type of wart, localized under the heel. Its considerable extension between the dermis and epidermis, far from the visible excrescence, may explain the absence of positive response to classical treatment in some cases.