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Summary Background Worldwide, 200 million girls and women have been subjected to female genital mutilation. To restore the clitoral function and vulvar anatomy, clitoral repair has been performed since the 2000s. Nevertheless, there is a lack of precise and comprehensive data on the clitoral anatomy during surgical repair. This study aimed to precisely describe the terminal anatomies of the dorsal nerve and artery of the clitoris, and the clitoral neurovascular flap advancement for reconstruction in patients with female genital mutilation. Methods This study was performed on seven fresh female cadavers. The site of origin, diameter, length, and trajectory of each nerve and artery were recorded. The clitoral neurovascular flap advancement was measured after a midline transection of the suspensory ligament was performed and after extensive liberation of the dorsal bundles at their emergence from the pubic rami. Results At the distal point of the clitoral body, the width of the dorsal nerve and artery was 1.9 ± 0.3 mm and 0.9 ± 0.2 mm, respectively. The total length of the dorsal bundles was 6.6 cm (± 0.4). The midpart of the suspensory ligament was sectioned, which allowed a mean anteroposterior mobility of 2.7 cm (± 0.2). Extensive dissection of the neurovascular bundles up to their point of emergence from the suspensory ligament allowed a mean mobility of 3.4 ± 0.2 cm. Conclusion We described the anatomical characteristics of the dorsal nerve and artery of the clitoris and the mobility of the clitoral neurovascular flap for reconstruction post clitoridectomy. This was done to restore the anatomic position of the glans clitoris while preserving and potentially restoring clitoral function in patients with female genital mutilation.

Resume Objectif La perte de substance totale de la levre inferieure est rare et sa reconstruction difficile. Les enjeux sont aussi bien esthetiques que fonctionnels. La suspension de la levre inferieure est essentielle pour restaurer la continence labiale. Nous rapportons une technique originale et simple de suspension par double haubanage nasogenien. Methode Deux lambeaux orbitonasogeniens a base superieure, etendus sur plusieurs centimetres sous les commissures labiales sont leves et completement desepidermises. Ils sont ensuite tunnelises et fixes a la levre inferieure reconstruite afin de lui assurer une suspension efficace aux maxillaires. Resultats Dans notre experience, nous avons utilise le haubanage nasogenien associe a une reconstruction totale de la levre inferieure pour trois patients avec une continence labiale assuree a long terme. L’etude de la litterature montre que l’utilisation des lambeaux locoregionaux conventionnels retablit une bonne continence labiale mais reste limitee a des pertes de substance subtotales. Les lambeaux pedicules a distance ou libres realises sans suspension ne restaurent pas la continence labiale. Plusieurs techniques d’haubanage de la levre inferieure par bandelettes de fascia lata ou tendon du long palmaire, associees ou non a un lambeau libre, semblent apporter une continence labiale de la levre inferieure satisfaisante. Tous ces procedes sont peu standardises et techniquement difficiles a realiser. Conclusion La technique du double haubanage nasogenien que nous decrivons semble etre une alternative efficace et interessante par sa simplicite, sa reproductibilite et son adaptabilite. Elle permet d’obtenir un plan posterieur parfaitement fixe, capable de recevoir n’importe quel moyen de couverture externe.

Resume Introduction La reconstruction mammaire par implant presente des inconvenients a long terme et conduit un nombre croissant de patientes a demander une chirurgie secondaire de correction. Deux strategies chirurgicales sont possibles : le changement d’implant (associe a des gestes de capsulectomie/capsulotomie et/ou lipofilling) et le retrait d’implant associe a l’apport d’un tissu autologue (lambeau et/ou lipofilling). Methode Entre 2010 et 2018, 54 patientes ont beneficie d’une chirurgie secondaire de correction d’une premiere reconstruction mammaire par implant. Les motifs d’insatisfaction de la reconstruction initiale, les interventions realisees et les complications postoperatoires ont ete analyses. Le bien-etre et la satisfaction des patientes ont ete evalues au moyen du questionnaire BREAST-Q. Resultats Trente-quatre patientes ont beneficie d’un changement de prothese et 20 patientes d’un retrait definitif de leur prothese associe a l’apport d’un tissu autologue. La presence d’une coque periprothetique, la douleur, l’aspect fige du sein et l’asymetrie mammaire etaient les motifs d’insatisfaction les plus frequents. Avec un recul moyen de 2,6 ans, les patientes ayant beneficie d’une conversion autologue etaient globalement plus satisfaites de l’aspect de leurs seins que les patientes ayant conserve un implant mammaire (p Conclusion En cas de mauvais resultat esthetique ou fonctionnel d’une reconstruction mammaire par implant, le retrait de la prothese associe a une reconstruction autologue donne de meilleurs resultats en termes de bien-etre et de satisfaction que le changement d’implant.

Resume Introduction Le pansement d’alginate de calcium pur (l’ALGINATE) et le traitement par pression negative (TPN) sont frequemment utilises pour la preparation d’une exerese a la greffe de peau mince. Cette etude a compare l’efficacite cicatrisante de ces deux produits, leur securite et le cout de prise en charge des patients. Patients et methodes Cent treize patients avec une exerese chirurgicale traitee par l’ALGINATE ou le TPN ont ete inclus dans cette etude randomisee de non-inferiorite. Le critere principal etait le delai d’obtention d’un tissu de bourgeonnement permettant une greffe de peau mince. Les criteres secondaires etaient la survenue d’evenements indesirables (EI) et l’impact de l’utilisation des deux produits sur le budget de l’Assurance Maladie. Resultats L’ALGINATE et le TPN ont permis l’obtention d’un bourgeonnement optimal dans un delai similaire : environ 20 jours. Aucun patient ALGINATE n’a presente d’EI alors que 24 % de patients TPN ont presente un EI. Apres l’hospitalisation, 94 % des patients ALGINATE etaient pris en charge a domicile par un infirmier liberal alors que 90 % des patients TPN etaient suivis en SSR ou en HAD. Par consequent, le cout de prise en charge, par patient, pour l’Assurance Maladie, etait de 498 € avec l’ALGINATE vs 2104 € avec le TPN. Conclusion Cette etude a demontre que l’ALGINATE a une efficacite cicatrisante similaire a celle du TPN, est mieux tolere et permet une economie financiere considerable. L’ALGINATE devrait etre privilegie dans cette indication.

Breast reconstruction by abdominal flap has evolved to ensure minimal donor-site morbidity with the description of Deep Inferior Epigastric artery Perforator flap (DIEP flap). Being of the same thickness and the same surface, the Superficial Inferior Epigastric Artery flap (SIEA flap) does not require, for it harvesting, to open the abdominal fascia or to dissect through the muscles minimizing again donor-site sequelae. However, it is little used because of the variability of its vascularization and a higher failure rate than the DIEP in the literature. We believe that it is reasonable, in some cases, to harvest a SIEA flap instead of DIEP flap in mammary reconstruction. We present a technical note explaining our operative strategy for reliably taking a SIEA when the caliber of the vessels allows.

The reconstruction of the columella is challenging and poorly evaluated in the literature. Our study aimed to evaluate retrospectively the different techniques used in our center and to propose an algorithm of reconstruction adapted to each patient. We report a retrospective cohort study included 18 patients (9 men and 9 women; 53 years-old in average) with columellar reconstruction treated from 1999 through 2014. Six different techniques were used: chondrocutaneous graft, nasolabial flap, paramedian forehead flap and scalping flap according to the Converse technique or the Raulo technique. Four independent plastic surgeons evaluated the aesthetic result on a 10 cm visual analogue scale comparing the patients' photographs before and after the reconstruction. Furthermore, we asked the patients to perform the same evaluation, and to evaluate their level of satisfaction. The mean follow-up was 4 years. Three chondrocutaneous grafts were performed to reconstruct partial defects (Surgical Evaluation (SE): 7.9, Patient Evaluation (PE): 8.3).Three bilateral nasolabial flaps (SE: 6.1, PE: 6.7), 5 paramedian forehead flap (SE: 6.9, PE: 7.3) 6 Converse scalping flap (SE: 4.9, PE: 5.4) and 1 Raulo scalping flap (SE: 6,1, PE: 6,3) were performed to reconstruct total defects exceeding the columella. The use of composite graft was the most satisfactory procedure for partial defects. Paramedian forehead flaps and Raulo scalping flap were the most satisfactory procedures for extended defects. Nasolabial flap was the most adapted procedure for patients with general anesthesia contraindication or for defects extended to the lip.

The tracheostomy procedure presents some long term complications such as the depressed scar. It can be responsible for a tracheal tug, invaginated scar, inaesthetic scar or all of them. No consensus has emerged in the treatment of this type of pathological scarring. We want to propose a new surgical approach to correct all these three pathological scarring mechanism by a subcutaneous flap in single operation.

International audience; Background External radiotherapy has become indispensable in oncological therapies. Unfortunately, radiation is responsible for serious side effects, such as radiodermatitis. The skin is weakened and ulcerated. Our study aimed to evaluate the subcutaneous transfer of microfat (MF) alone and two mixes: MF + Platelet-rich plasma (PRP) and MF + stromal vascular fraction (SVF) to treat radiation-induced skin lesions.Method We defined randomly five experimental groups of nine mice: 1 healthy control group and 4 irradiated (60 Grey) and treated groups. The skin lesions were treated 3 months after irradiation by MF, MF + PRP (50%–50%), MF + SVF (90%–10%) or Ringer-lactate subcutaneous injections. Wound healing was evaluated at 1, 2 and 3 months post-injection and histological wound analysis at 3 months, after euthanasia.Results All the irradiated mice presented with wounds. After sham-injection, the wound area increased by 91.1 ± 71.1% versus a decrease of 15.9 ± 23.1% after MF alone (NS), 27.3 ± 23.8% after MF + SVF (NS) and 76.4 ± 7.7% after MF + PRP (P = 0.032). A significative reduction of skin thickness in wound periphery was measured for the three treated groups compared to sham-injection (P < 0.05) but not in the healed wounds (NS). The most important subcutaneous neo-vessel density was shown after MF + SVF injection.Conclusion The MF + PRP mix was the most efficient product to increase healing. The MF + SVF mix showed the highest rate of neo-angiogenesis but was disappointing in terms of healing.

Summary Background To minimize the risk of viscera exposure for parietal or calverial reconstruction after tumor removal, we used the two-stage free flap strategy. The flap was transferred a few days before tumor resection and left in a standby position until the second stage. Patients and method We conducted a retrospective monocentric study. All patients who underwent reconstruction with the two-stage free flap strategy after tumor resection since 2000 were included. Results We performed 14 two-stage flaps (8 for calvaria, 3 for abdomen, and 3 for thorax) on 12 patients. The average skin paddle surface was 318 cm2. The mean operative time was 274 min for the first stage and 172 min for the second stage. The average time between the two stages was 8.8 days (2 to 24 days). One flap necrosis, one venous thrombosis, and one hematoma were observed after the first stage. Partial skin paddle necrosis (2 flaps) and infections (3 flaps) occurred after the second stage. The mean follow-up was 20 months (6 to 61 months), and two patients had tumor recurrence. Conclusions The two-stage free flap strategy is another option for major oncological reconstructions, to be safe and reliable some rules must be followed. The flap must contain a large skin paddle to ensure flap autonomization and to allow for complete tight plication of the flap between the two stages, which limits germ colonization. A short delay between the two stages (

Supplemental Digital Content is available in the text., Background: A calcium alginate dressing (ALGINATE) and negative pressure wound therapy (NPWT) are frequently used to treat wounds which heal by secondary intention. This trial compared the healing efficacy and safety of these 2 treatments. Methods: This randomized, non-inferiority trial enrolled patients who underwent skin excision (>30 cm2), which was left open to heal by secondary intention. They received ALGINATE or NPWT by a centralized randomization. Follow-up was performed weekly until optimal granulation tissue was obtained. The primary outcome was time to obtain optimal granulation tissue for a split thickness skin graft take (non-inferiority margin: 4 days). Secondary outcomes were occurrence of adverse events (AEs) and impact of the treatments on the patient’s daily life. Results: ALGINATE and NPWT were applied to 47 and 48 patients, respectively. The mean time to optimal granulation was 19.98 days (95% CI, 17.7–22.3) with ALGINATE and 20.54 (95% CI, 17.6–23.5) with NPWT. Between group difference was −0.56 days (95% CI −4.22 to 3.10). The non-inferiority of ALGINATE versus NPWT was demonstrated. No AE related to the treatment occurred with ALGINATE versus 14 AEs with NPWT. There was no difference in the impact of the treatments on the patient’s daily life. Conclusion: This trial demonstrates that ALGINATE has a similar healing efficacy to that of NPWT and that is markedly better with regard to patient safety.

Resume Introduction Les infections sont une complication frequente lors des reconstructions par prothese totale massive du genou (PTMG) apres resection tumorale large. En cas d’indication de couverture par lambeaux libre, les lambeaux musculaires sont le plus souvent preferes. Nous presentons ici une technique de sauvetage du membre par lambeau libre fasciocutane antero-lateral de cuisse (ALC). Methode Trois patients ayant une infection de PTMG apres exerese de sarcome du femur ont beneficie d’un lambeau ALC libre. Le prelevement du lambeau et la reimplantation de la prothese ont ete realises en deux temps operatoires. Resultats Le transfert du lambeau et le remplacement de la prothese ont ete realises sans complication. Apres deux ans, les membres ont pu etre conserves sans recidive infectieuse. Conclusion Le lambeau libre ALC represente une solution efficace de couverture en cas d’infection de PTMG et peut-etre considere comme une alternative valable aux lambeaux musculaires libres.

Introduction The gastrocnemius muscular flap has already proven its efficiency for soft tissue coverage in cases of knee joint exposure. However, it may be too small to cover large defects and has not the same aesthetic and mechanical properties as normal skin. Perforator fasciocutaneous flaps have recently been described in knee joint coverage with good results as they replace skin by skin, but they can be hard to harvest. Gastrocnemius flaps can be easily harvested with a planned skin paddle designed over the chosen muscle. This simple technique combines the advantages of muscular and fasciocutaneous flaps for knee joint area coverage. Perforator fasciocutaneous flap take a growing place in coverage of this localization in recent literature, but very few articles report the results of gastrocnemius myocutaneous flaps (MCFs). Methods All patients who underwent knee joint coverage with the use of a lateral or medial gastrocnemius MCFs between January 2012 and February 2017 in our university institution were included in this retrospective study. Results Sixteen gastrocnemius MCFs (10 medial and 6 lateral) were performed. The indication was posttraumatic in 5 cases, posttumoral in 5 cases, and after total knee prosthesis exposure in 6 cases. Skin paddles up to 15 cm in width and 18 cm in length were harvested. Complete healing was achieved in 15 days in all cases without suffering or nonunion. Three flaps were secondarily raised to allow total knee prosthesis reimplantation or arthrodesis, and 4 patients were treated with postoperative radiotherapy without complication. Conclusions In addition to its reliability and very easy harvesting, the gastrocnemius MCF allows a robust joint coverage and good skin resurfacing that makes eventual revision easier and allows early radiotherapy. Furthermore, skin paddle also increases the effective area of the flap. This technique should always be considered with the other classic alternatives.

Summary Background Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks’ abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. Material and methods This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. Results Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the “screening” group than in the “no screening”: 20,3% versus 41,5% (P = 0,002). Alike, complications were significantly less frequent in the “screening” group than in the “no screening”: 18,1% versus 42,3% (P Conclusion The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking.

Resume Introduction La mastectomie bilaterale de reassignation sexuelle vers l’homme est la premiere et souvent l’unique intervention chirurgicale permettant au patient transsexuel d’acceder physiquement au sexe masculin. C’est une chirurgie specialisee necessitant un accompagnement psychologique particulier. L’objectif de notre etude etait d’evaluer la satisfaction des patients operes de mastectomie bilaterale de reassignation vers le sexe masculin et l’impact sur leur vie sociale et personnelle. Materiel et methode L’ensemble des 22 patients operes entre janvier 2012 et mars 2013 pour mastectomie bilaterale de reassignation ont ete contacte par courrier pour etre inclus dans l’etude. La satisfaction apres intervention etait mesuree par auto-questionnaire adapte du questionnaire de reconstruction mammaire du Q-Breast modifie pour la chirurgie de reassignation sexuelle. Un score global superieur a 320/378 etait considere comme « tout a fait satisfaisant ». Resultats Seize patients sur 22 (73 %) ont repondu au questionnaire. Le score moyen etait de 332/378, correspondant a un resultat « tout a fait satisfaisant ». Le score d’evaluation du bien-etre psychologique etait de 54,5/60. Conclusion Notre etude a confirme le benefice reel de la chirurgie de mastectomie bilaterale dans le processus de reassignation sexuelle vers l’homme, a la fois en termes de qualite de vie et de confiance en soi. Les patients ont rapporte une importante satisfaction quelle que soit la technique utilisee et une amelioration de l’integration sociale apres chirurgie. Cependant, cette chirurgie ne doit s’envisager que dans le cadre d’une prise en charge globale par une equipe multidisciplinaire experimentee.

Resume But de l’etude Cinq cas d’une meme malformation congenitale du nez sont presentes, dont il ne semble pas exister d’equivalent dans la litterature. Cette malformation touche l’arete nasale et le supra-tip. Nous souhaitions presenter cette pathologie. Patients et methodes Cinq patients presentant une malformation nasale congenitale similaire non decrite dans la litterature ont ete pris en charge entre 1994 et 2014. Ces patients ont ete examines afin de decrire finement la malformation. Des analyses genetiques et histologiques ont ete realisees. Leur prise en charge diagnostique et therapeutique a ete discutee. Resultats La malformation decrite presente 4 composantes : une masse de tissu mou situee au niveau du tiers moyen de l’arrete nasale, les domes des cartilages alaires qui sont refoules et deformes vers le bas et en dehors par la masse, un defaut de soutien de la pointe et une atrophie cutanee mediane. Ils ne presentent pas d’autres anomalies de la ligne mediane. L’analyse histologique n’a pas apporte d’element diagnostique, ni l’analyse caryotypique bien que deux patients soient freres. Trois patients ont ete operes dont un jusqu’a l’âge adulte avec un resultat satisfaisant. Conclusion Les recherches bibliographiques n’ont pas permis de poser un diagnostic precis sur cette malformation qui semble etre non syndromique et a caractere familial. Notre attitude therapeutique est en faveur d’une exerese precoce de la masse adipeuse pour prevenir les deformations alaires, a associer avec un greffon cortico-spongieux, qui dans notre experience croit avec l’âge, pour soutenir la pointe.

Since the first description of Kasabach-Merritt syndrome (KMS) in 1940, many treatments have been proposed combining pharmacologic and non-pharmacologic approaches, which can be effective on the pathology but can have adverse and unpredictable side-effects with long-term use. Herein we describe the solely surgical treatment of Kasabach-Merritt syndrome in a neonate with a severe and rapidly progressive thrombocytopenia. The patient's condition normalized at 7 days postoperatively, with rapid increase in platelet count and normalization of d-dimer concentration.

Background Platelet-rich plasma improves engraftment after fat transfer. However, the effects of platelet dose have never been investigated. The authors used magnetic resonance imaging to compare surviving graft volumes in mice after administration of four different formulations (microfat alone, and three platelet-rich plasma-enriched microfat mixes). Methods The authors used a random, double-blinded, fat transfer protocol using three different platelet levels: 1 million (low-dose), 500 million (medium-dose), and 1000 million (high-dose) platelets/ml, and fat alone (control). The authors grafted 0.4 ml of the 70/30 platelet-rich plasma-enriched microfat mixtures (0.4 million, 200 million, and 400 million platelets per 0.12 ml for the low-dose, medium-dose, and high-dose mixtures, respectively) or 0.4 ml of microfat alone into 22 nude mice and monitored surviving graft volumes every month for 3 months. Then, the authors histologically analyzed all grafts to assess neoangiogenesis status and fat integrity. Results Three-dimensional magnetic resonance imaging showed that the median surviving graft volumes at 3 months were 9.5 percent (interquartile range, 0 to 25 percent; p = 0.003) (high-dose), 4.1 percent (interquartile range, 0 to 18 percent; p = 0.001) (medium-dose), and 18 percent (interquartile range, 8 to 38 percent; p = 0.41) (low-dose) compared to 36 percent (interquartile range, 28 to 53 percent) for the control value. The histologic integrity of microfat-alone grafts was significantly better than those of the other grafts, although the high-dose and low-dose grafts exhibited higher levels of neoangiogenesis. Conclusion Higher platelet levels in microfat grafts were associated with poor graft survival in nude mice; a clinical review would be appropriate.

Lipofilling or fat grafting transfer is defined as a technique of filling soft tissue by autologous fat grafting. The basic principle of lipofilling is based on a harvest of adipose tissue, followed by a reinjection after treatment. Lipofilling main objective is a volume defect filling, but also improving cutaneous trophicity. Lipofilling specificities among children is mainly based on these indications. Complications of autologous fat grafting among children are the same as those in adults: we distinguish short-term complications (intraoperative and perioperative) and the medium and long-term complications. The harvesting of fat tissue is the main limiting factor of the technique, due to low percentage of body fat of children. Indications of lipofilling among children may be specific or similar to those in adults. There are two types of indications: cosmetic, in which the aim of lipofilling is correcting a defect density, acquired (iatrogenic, post-traumatic scar) or malformation (otomandibular dysplasia, craniosynostosis, Parry Romberg syndrom, Poland syndrom, pectus excavatum…). The aim of functional indications is correcting a velar insufficiency or lagophthalmos. In the paediatric sector, lipofilling has become an alternative to the conventional techniques, by its reliability, safety, reproducibility, and good results.

Resume Les malformations palpebrales de l’enfant peuvent etre isolees ou associees a des syndromes malformatifs craniofaciaux. Leur evaluation est surtout clinique, les examens complementaires sont realises pour faire le bilan des malformations craniofaciales associees. Un bilan genetique doit etre demande systematiquement en cas de lesions extrapalpebrales associees ou de malformations palpebrales complexes. Tandis que certaines malformations isolees ne necessitent qu’une simple surveillance, d’autres ont besoin d’un traitement adapte. Celui-ci devra etre realise a un âge precis. Il prend en compte la croissance de l’enfant, des structures anatomiques et les consequences de la malformation sur l’œil et la vision (degre d’urgence). Ces anomalies s’accompagnent de deux risques principaux : l’irritation corneenne par inocclusion palpebrale et l’amblyopie par obstruction de l’axe visuel, par anisometropie ou par strabisme.

Wrist osteoarthritis (OA) is one of the most common conditions encountered by hand surgeons with limited efficacy of non-surgical treatments. The purpose of this study is to describe the Platelet-Rich Plasma (PRP) mixed-microfat biological characteristics of an experimental Advanced Therapy Medicinal Product (ATMP) needed for clinical trial authorization and describe the clinical results obtained from our first three patients 12 months after treatment (NCT03164122). Biological characterization of microfat, PRP and mixture were analysed in vitro according to validated methods. Patients with stage four OA according to the Kellgren Lawrence classification, with failure to conservative treatment and a persistent daily painful condition &gt, 40 mm according to the visual analog scale (VAS) were treated. Microfat-PRP ATMP is a product with high platelet purity, conserved viability of stromal vascular fraction cells, chondrogenic differentiation capacity in vitro and high secretion of IL-1Ra anti-inflammatory cytokine. For patients, the only side effect was pain at the adipose tissue harvesting sites. Potential efficacy was observed with a pain decrease of over 50% (per VAS score) and the achievement of minimal clinically important differences for DASH and PRWE functional scores at one year in all three patients. Microfat-PRP ATMP presented a good safety profile after an injection in wrist OA. Efficacy trials are necessary to assess whether this innovative strategy could delay the necessity to perform non-conservative surgery.

BACKGROUND Free tissue transfer is occasionally necessary during reconstruction of large scalp and calvarial bone resections. A single-stage procedure is usually performed but if a flap becomes necrotic it exposes brain tissue or the meninges. Performing a two-stage procedure, the surgeon must preserve flap vitality and manage flap complications before resecting a tumor, and therefore before exposing the brain or meninges. We report here the first series of two-stage free-flap reconstruction during major neurosurgical resection. METHODS From 2012 to 2018, nine free-flaps were performed to eight patients (61 years-old, on average). Average skull resection was 10.1 cm × 15 cm (range 6-18 cm × 9-24 cm). It was performed in all cases due to large malignant tumors. Resection/reconstruction was performed in all case in a two-step procedure: during the first step, the free-flap was harvested and anastomosed to the cranial site; during the second step, resection was performed and the flap was positioned into the defect to assure coverage. RESULTS Average flap size was 11.3 cm × 17.7 cm (range: 7-20 cm × 11-30 cm). Two flap complications occurred after the first stage and one flap did not survive. One patient died before the second stage. Seven patients had the second procedure; no flap complication occurred. All procedures ended in complete wound healing. Follow-up period was 41.5 months on average (range: 10-83 months). Final outcome was total remission for two patients, recurrence for four patients, and two patients died. CONCLUSIONS Our data suggest that the two-stage free-flap reconstruction may be employed for major scalp and calvaria resection.

Resume But de l’etude Nous presentons le cas d’une patiente presentant un syndrome de Goldenhar associe a une fistule congenitale situee au milieu du philtrum au niveau de la levre superieure. Patients et methode La patiente a ete prise en charge des sa naissance pour un syndrome de Goldenhar. Plusieurs interventions ont ete realisees dans l’enfance afin de corriger une macrostomie droite et une hypoplasie mandibulaire droite. A l’âge de 14 ans, elle beneficie d’une rhinoplastie pour corriger une malformation nasale complexe. En peroperatoire un orifice situe dans l’espace inter-incisif median superieur est decouvert. Il se prolonge par une fistule qui se dirige a travers la voute palatine anterieure en direction du rail vomerien, a la base de la cloison. Cette fistule est borgne en arriere du vomer et peut etre resequee en totalite. L’examen anatomopathologique de la piece revele un revetement malpighien. Resultats Les fistules medianes de la levre superieure sont extremement rares : moins de 30 cas reportes dans la litterature. Le trajet inhabituel de la fistule et l’apparition recente d’un syndrome hypophysaire chez cette patiente nous a fait rechercher une continuite entre celle-ci et la poche de Rathke par une imagerie de type tomodensitometrie. Conclusion L’association d’un syndrome de Goldenhar et d’une fistule congenitale mediane de la levre superieure n’a jamais encore ete decrite dans la litterature. L’association a un hypopituitarisme a fait suspecter un prolongement posterieur de la malformation, non confirme par le scanner, mais fortement presume conjointement par l’equipe de neurochirurgie et de chirurgie plastique.

Background and Objective A temperature increase can improve wound healing by activation of heat shock protein 70 and stimulation of fibroblasts. Since keloids are a dysfunction of collagen fiber synthesis and organization, this study aimed to evaluate if a 1,210 nm diode laser could have effects in a new animal model of keloid scars. Study Design/Materials and Methods A total of 39 nude mice were used for this study. Phototypes IV and V human keloids were grafted into their backs and after 1 month of healing, the mice were divided into four groups: Control, Laser, Resection, Resection/Laser. In the Laser group, the keloids were treated with a 1,210-nm diode-laser with the following parameters: 4 W; 10 seconds; fluence: 51 J/cm2; spot: 18.9 × 3.7 mm2. In the Resection group, surgical intra-lesional excision was performed. In the Resection/Laser group, keloids were treated with the 1,210-nm laser-diode after surgical intra-lesional excision. Temperature measurements were made during the laser treatment. Clinical examination and histological study were performed on the day of treatment and 1 month, 2 months, and 3 months later. Results Mean temperature measurement was of 44.8°C (42–48°) in the Laser groups. No healing complications or keloid proliferation was observed in any group. Keloid histologic characters were confirmed in all grafts. No histologic particularity was observed in the laser groups in comparison with the Control and Resection groups. Conclusion First, this keloid animal model appears to be adapted for laser study. Secondly, the 1,210-nm diode laser does not induce keloid thermal damage in vivo. Further studies with different 1,210-nm laser diode parameters should be performed in order to observe significant effects on keloids. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc.

Background When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures. Methods We performed a single-center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow-up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long-term outcomes (functional and aesthetic) were studied and compared according to the type of flap. Results A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long-term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor-site morbidity, reconstruction using the ALT free flap had significantly better results (p Conclusions In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long-term functional outcomes. The ALT flap provides better cosmetic results than LD.

Resume Nous rapportons le cas d’une patiente de 55 ans atteinte d’une neurofibromatose de type I ou maladie de Recklinghausen. Elle presentait un schwannosarcome du nerf median, de haut grade de malignite, a l’union des tiers superieur et moyen du bras, au contact de l’humerus. Le traitement carcinologique de cette tumeur imposait une amputation du bras au niveau du col chirurgical de l’humerus, et donc une desarticulation d’epaule. Dans le but d’ameliorer la fonction residuelle du membre superieur, et afin de creer une pince latero-thoracique, nous avons decide de realiser un lambeau libre total d’avant-bras banque. Ce lambeau composite a ete compose du radius, de la totalite des muscles de l’avant-bras, ainsi que de la peau de la face anterieure de l’avant-bras, prelevee avec le pedicule radial proximal. Il a ete anastomose en proximal a l’artere axillaire apres osteosynthese humero-radiale par plaque. Le lambeau a permis a cette patiente active d’obtenir un moignon fonctionnel, retablissant la fonction du bras et permettant une action de pince.

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.

Resume Introduction La reparation d’une perte de substance (PDS) chondromuqueuse endonasale sans atteinte cutanee est une eventualite rare qui met en jeu le pronostic fonctionnel et esthetique. Nous rapportons un cas original d’utilisation d’un greffon composite chondrocutane auriculaire pour la reparation d’une PDS chondromuqueuse endonasale. Observation Il s’agissait d’une patiente âgee de 57 ans presentant une PDS importante apres exerese complete d’une malformation arterioveineuse. L’exerese a emporte une partie du dome cartilagineux, la crus laterale du cartilage alaire et la muqueuse adjacente. Une greffe composite d’origine auriculaire a permis une couverture efficace en un temps avec un resultat tres satisfaisant. Discussion L’utilisation de greffe composite endonasale est rarement presentee dans la litterature alors qu’il existe peu d’alternatives pour la reconstruction des pertes de substance chondromuqueuse endonasale.

Resume Une perte de substance (PDS) transfixiante etendue de la paroi abdominale impose une technique de chirurgie reparatrice. Les auteurs presentent un cas original de reconstruction parietale anterieure sous-ombilicale par la realisation d’un lambeau pedicule fasciocutane anterolateral de cuisse (ALC). Il s’agissait d’une femme de 80 ans presentant une eventration sous-ombilicale de 15 × 18 cm. Apres bourgeonnement du peritoine et l’echec de plusieurs greffes de peau, il a ete realise un lambeau pedicule ALC. Le lambeau etait compose du tissu cutane et sous-cutane et de fascia lata. La cicatrisation de l’abdomen a ete obtenue en 15 jours sans complication. La cicatrisation du site donneur du lambeau a ete obtenue en un mois apres la realisation d’une greffe de peau. Le lambeau ALC permet une couverture cutanee de tres bonne qualite sans sequelle du site donneur en une seule intervention. L’apport de fascia lata vascularise suture a l’aponevrose des muscles abdominaux a permis dans ce cas de ne pas mettre de plaque abdominale.

Resume La reconstruction du fourreau cutane de la verge impose un resultat fonctionnel et esthetique parfait, associant un haut degre d’elasticite cutanee pour permettre des erections regulieres a un aspect cosmetique satisfaisant. La demande de chirurgie esthetique d’augmentation penienne ne cesse de s’accroitre depuis plusieurs annees. La technique chirurgicale la plus communement utilisee est desormais la lipopenosculpture (LPS) d’epaississement et d’elargissement, associant une greffe adipocytaire a une section du ligament suspenseur de la verge. Un patient ayant beneficie d’une LPS a presente plusieurs annees apres une hypertrophie majeure du greffon adipocytaire, rendant impossible tout rapport sexuel, imposant de realiser une lipoaspiration. Cette lipoaspiration s’etant compliquee d’une necrose du fourreau cutane de la verge, une reconstruction etait necessaire et a consiste en une greffe de peau mince non expansee associee a du derme artificiel. Grâce a la technique de l’adaptation de la greffe de peau sur le penis en erection, l’utilisation de derme artificiel et la stabilisation externe par therapie a pression negative, la reconstruction du fourreau cutane de la verge permet d’obtenir d’excellents resultats esthetique et fonctionnel. Enfin, il n’est que rarement rapporte dans la litterature de complication du lipomodelage a type d’alteration du resultat esthetique apres prise de poids.

Resume Les escarres ischiatiques, frequentes chez le patient paraplegique, sont les plus difficiles a traiter, de mauvais pronostic et associees a un fort taux de recidive postoperatoire. De nombreuses techniques chirurgicales de couverture par lambeaux musculaires ou musculocutanes ont ete decrites. Nous rapportons l’utilisation originale d’un lambeau fasciocutane anterolateral de cuisse pediculee (ALCp) pour la couverture d’une escarre ischiatique depassee, au-dela de toute solution therapeutique classique, associee a une escarre trochanterienne. Il s’agissait d’un patient âge de 45 ans, paraplegique, presentant une escarre ischiatique et trochanterienne, qui avait deja beneficie d’une couverture par un lambeau musculaire de biceps femoral et de grand fessier. A un an, le resultat est satisfaisant, avec une bonne qualite de couverture, sans recidive. Le lambeau fasciocutane ALCp peut etre une solution pour la couverture des escarres ischiatiques recidivantes echappant aux procedes classiques.

Background Infection is a common complication of major lower limb-sparing surgery with massive total knee prosthesis (MTKP) reconstruction after extensive tumour resection. When free tissue transfer is required to cover the prosthesis, musculo-cutaneous flaps are usually preferred based on proven efficacy when used in both one-stage and two-stage procedures. The use of a free fascio-cutaneous antero-lateral thigh (FC-ALT) flap in 3 patients with infected knee reconstructions is reported here. Material and method A retrospective study was performed of 3 patients in whom a free FC-ALT flap was used during a two-stage procedure to treat MTKP infection after femoral sarcoma resection. Results Free FC-ALT flap transfer and exchange arthroplasty were successful in all 3 patients. Two years after the procedure, no patient had required amputation or experienced recurrent infection. Conclusion A free FC-ALT flap can provide adequate coverage of infected MTKP and deserves to be viewed as a valid alternative to free muscle flaps.

Keloids scars are a dysregulated response to cutaneous wound healing and can be associated with substantial physical and psychological distress. Unfortunately, they occur when surgical excision is performed. While the pathogenesis of keloids continues to be investigated, numerous treatment options exist. But there is still no ideal treatment. Their management needs association of treatment and long-term follow-up to observe and manage recurrence. In this second part, we propose a strategy for management of keloids scars.

Ischial pressure sores concern patients in the sitting position and particularly the rehabilitated patients. Spontaneous healing may be very difficult without surgery, and ischial pressure sores have the highest recurrence rate among other decubitus. Furthermore, there is no consensus concerning the ideal surgical technique in order to definitely treat the patients. This is a retrospective analysis of the surgical treatment of ischial pressure sores aiming to identify the ulcer recurrence rate per surgical technique and describe the early complications. This was a retrospective study that was conducted in Marseille, France, between 1988 and 2007. The medical records concerning patients with ischial pressure sores were collected and analyzed. The main objective was to identify the ulcer recurrence rate after ischial pressure sore surgical treatment. The secondary objective was the identification and description of early complications. Ninety-nine patients were finally selected and analyzed for 108 ischial pressure sore treatments. Primary endpoint analysis identified 25 recurrences for 108 sores (23.14 %). Hamstring V-Y advancement flap had 71 % recurrence rate. Wound dehiscence was the primary complication. Six out of seven hamstring V-Y advancement flaps had early complications. Pressure sore treatment can be difficult and challenging. In this retrospective study, we have found that the hamstring V-Y advancement flaps have a much higher recurrence rate and a higher rate of complications. Our results may be limited by the retrospective nature of this study but they imply that the V-Y advancement flaps should not be used as a first choice for ischial pressure sore treatment. Level of Evidence: Level IV, therapeutic study.

Resume Objectif Evaluer l’efficacite de la tomographie par coherence optique plein-champ pour differencier les cicatrices hypertrophiques des cicatrices cheloides sur des fragments tissulaires ex-vivo. Patients et methodes Tous les patients ayant beneficie de l’exerese d’une cicatrice pathologique entre novembre 2012 et septembre 2013 ont ete analyses. Les cicatrices ont ete fixees dans du formol puis analysees en histologie classique puis en tomographie a coherence optique plein-champ. Les criteres retenus pour l’evaluation etaient : presence de nodules dermiques, presence de cellules et hyalinisation du collagene. Resultats Dix-neuf cicatrices pathologiques ont ete analysees. En histologie, sept cicatrices etaient cheloides, sept etaient mixtes et trois etaient hypertrophiques. La sensibilite de la tomographie par coherence optique pour la detection des nodules dermiques etait de 100 %. Cette technologie n’etait pas satisfaisante pour la detection des cellules et de la hyalinisation du collagene. Conclusion Dans l’etat actuel de la technologie, la tomographie par coherence optique ne permet pas d’identifier la presence de cellules ce qui rend difficile le diagnostic differentiel dans le cas particulier des cicatrices hypertrophiques et cheloides.

BackgroundIn patients with systemic sclerosis (scleroderma, SSc), impaired hand function greatly contributes to disability and reduced quality of life, and is insufficiently relieved by currently available therapies. Adipose tissue-derived stromal vascular fraction (SVF) is increasingly recognised as an easily accessible source of regenerative cells with therapeutic potential in ischaemic or autoimmune diseases. We aimed to measure for the first time the safety, tolerability and potential efficacy of autologous SVF cells local injections in patients with SSc with hand disability.MethodsWe did an open-label, single arm, at one study site with 6-month follow-up among 12 female SSc patients with Cochin Hand Function Scale score >20/90. Autologous SVF was obtained from lipoaspirates, using an automated processing system, and subsequently injected into the subcutaneous tissue of each finger in contact with neurovascular pedicles. Primary outcome was the number and the severity of adverse events related to SVF-based therapy. Secondary endpoints were changes in hand disability and fibrosis, vascular manifestations, pain and quality of life from baseline to 2 and 6 months after cell therapy.FindingsAll enrolled patients had surgery, and there were no dropouts or patients lost to follow-up. No severe adverse events occurred during the procedure and follow-up. Four minor adverse events were reported and resolved spontaneously. A significant improvement in hand disability and pain, Raynaud's phenomenon, finger oedema and quality of life was observed.InterpretationThis study outlines the safety of the autologous SVF cells injection in the hands of patients with SSc. Preliminary assessments at 6 months suggest potential efficacy needing confirmation in a randomised placebo-controlled trial on a larger population.FundingGFRS (Groupe Francophone de Recherche sur la Sclérodermie).Clinical Trials numberNCT01813279.

Harvesting iliac crest bone in children is special because of the presence of a thick cartilage. Constant pressure on the internal iliac fossa, ascends the skin, and moves the abdominal muscles away from the iliac crest. A single incision is then used for cutaneous and subcutaneous dissection. An internal piece of cartilage is then removed and the iliac muscle retracted in order to harvest cortical and spongy bone from the internal side of the iliac crest. That piece of cartilage is then sutured at its initial place. During the harvesting, the surgeon needs to be careful to preserve the lateral femoral cutaneous nerve.

International audience; Free tissue transfers are sometimes required in the reconstruction of large full-thickness chest wall defects. To minimize the risk of viscera exposure in case of free flap complications, we describe a two-stage procedure using an anterolateral thigh flap.

Resume L’expansion cutanee est un processus long et delicat au cours duquel peuvent apparaitre des complications plus ou moins graves. Les donnees de la litterature retrouvent un taux global de complications variable allant de 13 a 37 %. Nous pouvons les classer en complications majeures pouvant aboutir a un echec du traitement voire a une aggravation de l’etat anterieur et en complications mineures ne compromettant pas le protocole d’expansion mais pouvant le modifier. Les principales complications majeures sont l’infection, la souffrance cutanee et la necrose pouvant aboutir a l’exposition de la prothese, les fuites et les problemes techniques avec dysfonction du materiel engendrant des difficultes et parfois meme un echec des gonflages. Les principales complications mineures sont les hematomes et les seromes, l’exposition de la valve ou de la tubulure, les douleurs avec paresthesies par compression des organes de voisinage, les cicatrices pathologiques et inesthetique et un retentissement psychologique important. Ces complications peuvent resulter d’un etat cutane precaire, d’un dysfonctionnement de materiel ou de problemes techniques inherents a la procedure mais egalement etre liees a une mauvaise indication ou planification preoperatoire. L’apparition d’une complication n’est cependant pas synonyme d’echec de la procedure ; une reconstruction satisfaisante peut-etre tout de meme obtenue dans pres de ¾ des cas. Cet article a pour but d’aider a identifier les situations a risque de complications afin de pouvoir les prevenir, les depister et les prendre en charge precocement.

Resume Le lymphome anaplasique a grandes cellules (LAGC) est une pathologie rare, son incidence aux Etats-Unis est de un cas pour 500 000 femmes et de trois pour 100 millions de patientes pour la seule localisation mammaire. Quarante-six cas ont ete recenses dans la litterature. Ils peuvent se developper sur tout type d’implant : expandeur, prothese en silicone et serum physiologique, enveloppe lisse ou texturee. Actuellement, le consensus de traitement comprend la capsulectomie, l’ablation de l’implant, la chimiotherapie et la radiotherapie. Cependant, certains auteurs le classent dans le cadre de pathologie indolente, mais nous pensons que certains cas peuvent echapper a toute therapeutique et deviennent des formes tres agressives. Il est donc important de faire un diagnostic precoce et commencer un traitement en urgence. Sa gravite et la suspicion du caractere iatrogene ont fait du LAGC une obligation d’information des futures porteuses d’implants.

Resume Introduction Le traitement des enfants atteints d’une paralysie obstetricale haute du plexus brachial est controverse. En effet, certaines equipes traitent chirurgicalement ces enfants en l’absence de contraction du biceps brachial des l’âge de trois mois, d’autres attendent au moins six mois, en l’absence de signes d’avulsion des racines, avant d’envisager un tel traitement. Nous pensons qu’un traitement conservateur comprenant une reeducation intensive adaptee permet d’obtenir de bons resultats fonctionnels chez les enfants recuperant spontanement entre trois et six mois et qu’il ne faut donc pas systematiquement operer ces enfants a trois mois. Afin d’argumenter cette prise en charge, nous avons compare l’evolution a long terme des enfants ayant une paralysie obstetricale haute traites medicalement en fonction du delai de recuperation de leur biceps brachial (avant ou apres trois mois). Patients et methodes Vingt-deux patients atteints de paralysie obstetricale haute, non operes, suivi a l’hopital de la Timone-Enfants a Marseille par une equipe pluridisciplinaire et ayant recupere une contraction du biceps brachial entre un et huit mois, ont ete inclus dans l’etude. Tous ont beneficies d’une reeducation intensive reguliere, depuis la naissance, par le meme kinesitherapeute. Les patients ont ete examines, photographies et la fonction de leur epaule a ete evaluee et notee selon la classification de Mallet. Le score de Mallet a ensuite ete analyse en fonction du delai de recuperation du biceps brachial. Resultats Les patients ont ete revus avec un recul moyen de 8,2 ans. Neuf enfants avaient recupere une contraction du biceps a l’âge de trois mois ou avant ; leur score global de Mallet etait en moyenne a 4,11. Treize enfants avaient recupere une contraction du biceps apres l’âge de trois mois (entre quatre et huit mois) ; leur score global de Mallet etait en moyenne a 3,92. Conclusion Cette etude montre que la fonction globale de l’epaule est comparable a long terme pour les deux groupes. Nous en concluons qu’une reeducation intensive et reguliere des enfants atteints de paralysies obstetricales hautes n’ayant pas recupere une contraction du biceps brachial a l’âge de trois mois peut permettre d’obtenir, a long terme, une fonction globale de l’epaule similaire a celle des enfants ayant recupere plus precocement. Cette prise en charge permet ainsi d’eviter des chirurgies precoces inutiles. Nous reservons le traitement chirurgical du plexus aux enfants n’ayant pas recupere (ni cliniquement ni electriquement) apres un minimum de six mois.

Resume Sujet La prise en charge des naevi geants demeure, a ce jour, sujet de discussions. Le curetage technique superficiel precoce permet un eclaircissement des lesions. Nous avons voulu preciser l’interet actuel de son utilisation a partir de resultats obtenus apres 20 ans d’experience. Patients et methodes Vingt-neuf patients ont ete traites par curetage entre 1991 et 2011. La chirurgie, qui consiste en l’exerese du derme superficiel, a ete realisee entre la premiere et septieme semaine de vie en 1,8 procedure en moyenne. Le resultat esthetique a ete juge de maniere subjective. Resultats La cicatrisation a ete obtenue en sept jours. Nous n’avons note que quelques complications locales, aucune complication generale. Les resultats esthetiques initiaux, avec un eclaircissement variable, ont induit une satisfaction parentale globale dans 100 % des cas. Une repigmentation secondaire heterogene et evolutive a ete observee dans tous les cas. Conclusion A ce jour, nous pensons que le curetage reste indique dans le traitement des naevi geants dans certaines localisations de traitement difficile par les techniques conventionnelles (par exemple, le sourcil, ceux associes a de nombreux naevi satellites) ou pour ceux ayant un retentissement psychologique trop important pour supporter un delai therapeutique.

Resume Nous presentons dans cet article original une etude histologique de residus cutanes operatoires. But de l’etude Cette etude a ete realisee dans le but de montrer de maniere objective la diversite qu’il existe au niveau de la peau saine en fonction de la zone anatomique, du sexe et de l’âge, d’expliciter des principes chirurgicaux admis desormais de tous, mais souvent mal illustres ou encore d’apporter un raffinement cosmetique supplementaire a nos indications. Patients et methode Sur une periode de deux ans, 141 patients ont ete selectionnes, il s’agissait de 69 hommes et 72 femmes. Les prelevements ont interesse 54 fois la region tete et cou (38,3 %), 34 fois le tronc (24,1 %) et 53 fois les membres (37,6 %). Au niveau de ces trois grandes regions, nous avions prealablement defini 35 zones d’interet, qui ont toutes ete etudiees a l’exception du menton et de la region cervicale anterieure. L’etude a consiste en l’analyse de residus cutanes operatoires et de peau peripherique saine de lesions benignes. Chaque prelevement apres son acheminement au laboratoire d’anatomopathologie a beneficie de la realisation de lames suivant quatre techniques differentes. Ainsi, une etude histologique complete a alors pu etre menee. Elle a consiste en une etude purement quantitative avec mesure des differentes couches cutanees, evaluation de la densite pigmentaire et mesure objective de la densite en fibres elastiques. Enfin, une analyse descriptive a ete menee zone par zone. Resultats Les resultats de l’analyse quantitative nous ont permis d’etablir des hierarchies entre les differentes zones et ce pour tous les parametres consideres. Ces resultats sont globalement en accord avec les donnees disponibles dans la litterature. Les resultats de l’analyse descriptive nous ont eux, permis de reveler les specificites regionales, avec illustration visuelle de l’existence au niveau de la face, notamment d’une veritable mosaique cutanee. Enfin, le croisement des deux analyses nous a permis d’enoncer des principes de bonne pratique en chirurgie reconstructrice quant au choix de la couverture cutanee la mieux adaptee en fonction des criteres etudies et de la zone consideree. Conclusion Cette etude qui represente l’ebauche d’une cartographie dynamique adaptee a la chirurgie plastique, n’a aucune pretention d’exhaustivite. Mais si modeste soit-elle, elle nous a fourni des resultats conformes aux donnees de la litterature et nous a conforte dans nos pratiques chirurgicales. Enfin, elle nous a permis de confirmer notre postulat de depart, a savoir qu’il n’existe non pas une mais des peaux.