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When one considers breast augmentation, it is quite important to study the patient thoracic morphology, since the ribs are the base on which the implant rests. They are responsible for the implant orientation, and, in part, for the breast projection. Some malformations are obvious, neither the surgeon nor the patient underestimates the difficulties... However, often exist discreet abnormalities, which don't stick out right away. One must not ignore them, because they affect the result of an ordinary augmentation procedure. They must be identified and evaluated prior surgery. Thus, she will not be surprised or disappointed if the result is not exactly symmetrical, or what she was expecting. Aesthetic surgery requires the same demand than reconstructive surgery. The physical examination must be very thorough, looking for any asymmetry, even minimal, concerning volume, skin and bone. The position of the implants must be discussed not only according to the type of implants (inflatable or gel filled) but also according to the state of the skin, the thickness of the subcutaneous tissue, the amount of gland and the shape of the thorax.

The aesthetic surgery of the breast goes from one side to the other: make it bigger if it is too small, make it smaller if it is too big, tighten the skin if it falls. The situation is very complex because of the facts that these disgraces can be associated with different levels of severity, and that woman has two breasts each one often different from the other. But, if natural asymmetry is found so often, the surgeon should not reproduce it. Some problems cannot be solved yet: long time tolerance to the breast implants, unknowledge of the way the skin would heal, a very important factor for the reduction plasties. This surgery is a balance with two dishes: for example, the result that we are waiting for must not to be spoiled by a too big scar to obtain a small cosmetic benefit. The indications to operate should be given after they have been judged carefully and notified the patient very clearly about the advantages, inconveniences and expected complications.

The technique of tissue expansion is rapidly developing. It resolves certain problems encountered in plastic and reconstructive surgery, in the scalp, for example, which constitutes an ideal indication. A correct strategy and technique, together with well defined indications allows a very significant reduction in the complication rate. The choice of prosthesis and its location also play an important role. There are many indications in the scalp, but tissue expansion may also be useful in Poland's syndrome, in giant naevi in children and for expansion of certain flaps. Rapid intra-operative expansion also appears to be a promising technique.

Following a summary of the principles of quantum physics required to understand how lasers work, the main lasers used in therapeutics are described, together with their characteristics. Only the argon laser is used in the treatment of port wine stains. The selection of cases for laser treatment is based on such criteria as colour of the lesion, speed of recoloration and patient's age. Local complications are sometimes observed. The argon laser undoubtedly constitutes a progress in the treatment of port wine stains, a condition where surgery remains disappointing.

A thirty-nine-year-old caucasian man presented with an ulceration of the scalp, developing on an alopecia. The scalp indeed had been burnt by boiling water when the boy was two. During childhood and youth microtraumatisms induced superficial wounds which always healed easily. Nine months ago, a new ulceration followed a new trauma; the wound did not heal, and lay on a dark brown area. A biopsy diagnosed a malignant melanoma. The whole alopecic area was resected, under the ulceration and the pigmented area, as well as the external surface and the diploe. The defect was covered with a free transplant of omentum, revascularized by microsurgical anastomoses to the external carotid artery and the external jugular vein in the parotid bed. The omentum was immediately covered with split-thickness skin grafts. Histologic investigations demonstrated the association of a melanoma developing on a Hutchinson melanotic freckle and a squamous cell carcinoma.

The authors describe the results of 60 cases of trunk repairs, carried out by the same surgeon, and with a follow-up period of 18 months or more. The grafts were autologous and in most cases the donor was the saphenous nerve. The grafts were placed under microscope. The recipient sites were the median nerve (19 cases), the ulnar nerve (16 cases), the radial nerve (10 cases), the sciatic nerve (8 cases), the musculo-cutaneous nerve (6 cases) and the spinal nerves (1 case). After a description of the technique used, the results are analyzed in accordance with the classical criteria of Highet and Holmes, to which has been added the notion of harmony of movement. The overall evaluation has been carried out in accordance with the following scale: two-point discrimination less than 15 mm + M4 or M5 + harmony = very good; two-point discrimination impossible to interpret, protective sensitivity S2 + M4 or M5 + harmony - good; crude protective sensitivity (S1) + M3 or less X average. Of the 60 cases, 21 ranks as very good and 22 as good, together giving an aggregate 72% of the total, with 12 cases ranking as mediocre and 5 failures. The incidence on these results of the following factors in then considered: the patient's age, the nerve damaged, the level of the injury in a given nerve, the time intervening between the initial lesion and the repair, the length of the nerve injury, the number of fascicles, the quality of the tissues and the surgeon's experience. It would seem that the best chances of success involve: a patient aged under 30, a short intervening period (less than 6 months between accident and repair), an injury less than 5 cms long, the maximum number of fascicles, good quality tissues and an experienced surgeon.