Laser
A comparative study of combined treatment with fractional carbon dioxide and targeted ultraviolet B phototherapy for facial vitiligo
Monday, June 13, 2016, 14:55
Abstract
Facial vitiligo is associated with considerable psychological impact. The management is challenging and requires multidisciplinary treatment. Adding fractional carbon dioxide (CO2) to the conventional treatment has been reported as an effective modality. This study aimed to evaluate the efficacy of combined fractional CO2 laser, targeted ultraviolet B (UVB) phototherapy, and topical steroid on facial vitiligo. A prospective, randomized, split face study was conducted on 14 patients with symmetrical non-segmental facial vitiligo. Ten sessions of fractional CO2 laser was performed on the lesions on one side of face with 2-week interval. Immediately after laser, the lesions on both side of face were treated with 10 sessions of 2-week interval targeted UVB phototherapy and twice daily application of topical 0.05 % clobetasol propionate cream. The patients were followed up for 12 weeks after the last treatment. Clinical improvement was graded by blinded dermatologists and patients using a quartile grading scale. Twelve out of 14 patients completed the study. The degree of improvement was not different between both sides in nine patients. One patient showed more improvement on the combined laser side, and two patients showed inferior results on the combined laser side. Two patients with lesser improvement on the laser-treated side had positive Koebner phenomenon on the non-facial area. The combined treatment with laser, targeted UVB, and topical steroids are not superior to targeted UVB and topical steroids in facial vitiligo. Furthermore, laser may retard the response to the standard treatment in patients with Koebner phenomenon on non-treated areas.
Tags: Aesthetics
Laser
Breast cancer detection based on serum sample surface enhanced Raman spectroscopy
Saturday, June 11, 2016, 22:54
Abstract
Raman spectroscopy is a vibrational technique which provides information about the chemical structure. Nevertheless, since many chemicals are present in a sample at very low concentration, the Raman signal observed is extremely weak. In surface enhanced Raman scattering (SERS), Raman signals can be enhanced by many orders of magnitude when nanoparticles are used. To the best of our knowledge, this is the first report in the breast cancer detection based on serum SERS. The serum samples were obtained from 12 patients who were clinically diagnosed with advanced breast cancer and 15 controls. In the same proportion, the serum samples were mixed with colloidal gold nanoparticles of 40 nm using sonication. At least 10 spectra were collected of each serum sample using a Jobin-Yvon LabRAM Raman Spectrometer with a laser of 830 nm. Raw spectra were processed by carrying baseline correction, smoothing, and normalization and then analyzed using principle component analysis (PCA) and linear discriminant analysis (LDA). Raman spectra showed strongly enhanced bands in the 600–1800 cm −1 range due to the nanoparticle colloidal clusters observed. These Raman bands allowed identifying biomolecules present at low concentration as amide I and III, β carotene, glutathione, tryptophan, tyrosine, and phenylalanine. Preliminary results demonstrated that SERS and PCA-LDA can be used to discriminate between control and cancer samples with high sensitivity and specificity. SERS allowed short exposures and required a minimal sample preparation. The preliminary results suggest that SERS and PCA-LDA could be an excellent support technique for the breast cancer detection using serum samples.
Tags: Aesthetics
Plastic, Reconstructive & Aesthetic Surgery
Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo
Yoon Jae Lee, Hak Young Kim, En Young Rha, Jun Yong Lee, Hyun Ho Han · Saturday, June 11, 2016, 5:15
The fingertip is a common site of injury and the treatment of choice is controversial. Structural preservation is important as soft tissue and bone loss can result in detrimental hand disability1. Traditionally, simple revision amputation, skin graft, local flap or distant flap is used for reconstruction1,2. In the past, operative indications for a free flap on the fingertip were controversial; however, the recent development of supermicrosurgery, which has a high survival rate, has facilitated reconstruction of fingertip defects 3.
Tags: Aesthetics
Plastic, Reconstructive & Aesthetic Surgery
Urethra Reconstruction with Lateral Pectoral Flap in Female-To Male Transsexual Patients
Mehmet Bayramiçli, Zeynep D. Akdeniz · Saturday, June 11, 2016, 5:15
Formation of a neo-urethra is the most challenging part of phalloplasty in female-to-male transexual patients. The incidence of urologic complications is extremely high1,2,3 and strictures followed by fistula formation at the neo-urethra are common. Here we describe a lateral pectoral flap based on the superficial thoracic artery (STA) as a new technique for urethra prelamination on the radial forearm flap. The use of lateral pectoral flap based on this artery has been described for reconstruction of soft tissue defects4.
Tags: Aesthetics
Plastic, Reconstructive & Aesthetic Surgery
The Presentation of Plastic Surgery Visual Data from 1816 -1916: The Evolution of Reproducible Results
M. Felix Freshwater · Saturday, June 11, 2016, 5:15
All scientific data should be presented with sufficient accuracy and precision so that they can be both analyzed properly and reproduced. Despite our artistic nature, as scientists we plastic surgeons use visual data to achieve reproducible results by discerning details of procedures and differences between pre- and post-surgery images.This review highlights how the presentation of visual data evolved from 1816, when Joseph Carpue published his book on nasal reconstruction to 1916, when Captain Harold Gillies, RAMC began to treat over 2000 casualties from the Battle of the Somme.
Tags: Aesthetics
Laser
Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter
Friday, June 10, 2016, 22:52
Abstract
Lesion sizes and quality are crucial for successful catheter ablation procedures. We sought to test the influence of catheter orientation towards the endocardial surface on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter. Continuous wave 1064-nm laser catheter applications at 15 W (4.5 W/mm²)/30 s, (135 J/mm²), irrigation flow 30 mL/min, were aimed at the left ventricular endocardial surface of bovine myocardium. The catheter was kept in vertical, in slanting (67.5°, 45°, 22.5°), and in flat positions; in flat position, also 60 s of radiation times were applied (n = 10, each). Lesions were evaluated morphometrically. Maximum depth of lesion was achieved with the catheter in a vertical orientation. Catheter inclination of <22.5 showed a highly significant decrease of lesion depth from 5.6 ± 1.1 to 3.7 ± 0.5 mm (p = 0.0001). In a flat catheter position, laser radiation of 30 s achieved the smallest lesions. However, after 60 s of radiation, the flat lesions were similar in depth (p = 087) and were larger in width (p = 0.0004) and in volumes (p = 0.0025) as compared to the lesions achieved with the catheter in vertical position after 30 s of radiation. Steam-pop with intramural cavitation or tissue vaporization with crater formation did not occur. Longer radiation times can achieve larger lesions regardless of catheter orientation. Catheter orientation is not a major determinant for laser ablation lesion size and quality, and a steerable support may not be needed when using the open-irrigated electrode-laser mapping and ablation (ELMA) catheter RytmoLas.
Tags: Aesthetics
Ophthalmic Plastic & Reconstructive Surgery - Published Ahead-of-Print
Clinical Response to Tocilizumab in Severe Thyroid Eye Disease.
Sy, Aileen; Eliasieh, Kasra; Silkiss, Rona Z. · Friday, June 10, 2016, 12:00
Tocilizumab, in a preliminary study, was reported to be an effective therapy for moderate to severe thyroid eye disease. The authors describe the clinical response of 2 severe thyroid eye disease cases refractory to intravenous steroids and orbital decompression. Both patients demonstrated improved clinical activity scores with minimal side effects after tocilizumab therapy. In addition, post tocilizumab orbital fat biopsies demonstrated benign adipose tissue without evidence of inflammatory cells. (C) 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Tags: Aesthetics
Ophthalmic Plastic & Reconstructive Surgery - Published Ahead-of-Print
A Concomitant Case of Orbital Granuloma Faciale and Eosinophilic Angiocentric Fibrosis.
Chen, Valerie H.; Grossniklaus, Hans E.; Delgaudio, John M.; Kim, Hee Joon · Friday, June 10, 2016, 12:00
Granuloma faciale is an eosinophilic dermatosis that typically presents as red-brown facial plaques of middle-aged Caucasian men, while eosinophilic angiocentric fibrosis is a histologically similar fibrotic condition affecting the respiratory mucosa. Both are very uncommon conditions and pose a therapeutic challenge. While a handful of reports have reported concurrent presentation, the authors present the first case of eyelid granuloma faciale with eosinophlilic angiocentric fibrosis. (C) 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Tags: Aesthetics
Laser
Assessment of edema volume in skin upon injury in a mouse ear model with optical coherence tomography
Thursday, June 09, 2016, 22:38
Abstract
Accurate measurement of edema volume is essential for the investigation of tissue response and recovery following a traumatic injury. The measurements must be noninvasive and repetitive over time so as to monitor tissue response throughout the healing process. Such techniques are particularly necessary for the evaluation of therapeutics that are currently in development to suppress or prevent edema formation. In this study, we propose to use optical coherence tomography (OCT) technique to image and quantify edema in a mouse ear model where the injury is induced by a superficial-thickness burn. Extraction of edema volume is achieved by an attenuation compensation algorithm performed on the three-dimensional OCT images, followed by two segmentation procedures. In addition to edema volume, the segmentation method also enables accurate thickness mapping of edematous tissue, which is an important characteristic of the external symptoms of edema. To the best of our knowledge, this is the first method for noninvasively measuring absolute edema volume.
Tags: Aesthetics
JAMA Facial Plastic Surgery Online First
Expanding Roles and Broader Goals for Global Surgery
Tollefson Tt, Shaye D. · Thursday, June 09, 2016, 20:23
Global surgery is an emerging field within the widely known umbrella term of global health. A lack of data on surgically treatable disease states has been the biggest barrier to the necessary support and investments in global surgery. Most public health priorities address specific diseases (eg, malaria, human immunodeficiency virus, tuberculosis), whereas global surgery has only recently gained attention. Surgical volunteerism is very popular, but the more complex tasks of working with local health care systems in low- and middle-income countries (LMICs) are more difficult. Leadership and representation in public health arenas are needed to move the field toward the goal of "universal access to safe, affordable surgical and anesthesia care when needed. "(p834)
Tags: Aesthetics
JAMA Facial Plastic Surgery Online First
Cleft Lip and/or Palate Surgery in India
Stewart Bt, Carlson L, Hatcher K, Et Al. · Thursday, June 09, 2016, 20:23
This national population modeling study estimates the unmet need for cleft lip and/or palate surgery in India at the state level.
Tags: Aesthetics
Plastique Esthétique
Particularités de la cicatrisation de l'enfant
Thursday, June 09, 2016, 18:55
Publication date: Available online 8 June 2016
Source:Annales de Chirurgie Plastique Esthétique
Author(s): J. Sanchez, F. Antonicelli, D. Tuton, S. Mazouz Dorval, C. François
L'enfant présente des critères d'évolution cicatricielle spécifiques. Les objectifs de cet article sont la présentation clinique des particularités de la cicatrisation de l'enfant associée à un état des lieux sur les connaissances des mécanismes fondamentaux expliquant les différences d'évolution selon les âges. L'embryon peut cicatriser sans cicatrice grâce à l'absence de phase inflammatoire (macrophage), l'absence de tissu de granulation, la forte concentration en acide hyaluronique (liquide amniotique, dans la cicatrice), l'agencement et la concentration des collagènes, et à la présence de la ténascine. L'épaisseur cutanée est un facteur péjoratif dans la réparation tissulaire chez l'enfant. En revanche, les faibles comorbidités et les mécanismes physiologiques liés à la croissance sont une aide indéniable à la bonne évolution des plaies de l'enfant. La cicatrisation est souvent très rapide mais peut être explosive. À partir de l'âge de deux ans, l'hypertrophie cicatricielle est majorée, en durée et en intensité. En période pubertaire, les cicatrices hypertrophiques sont plus fréquentes. Tout geste chirurgical non urgent doit être évité durant cette période. Les traitements complémentaires (hydratation, massages, compression, orthèse, silicone, thermalisme…) ont une place importante dans la prise en charge des cicatrices pédiatriques. Après cicatrisation, la croissance peut être responsable de complications spécifiques telles que les brides cicatricielles, l'alopécie, l'invagination cicatricielle. Le caractère évolutif implique la nécessité du suivi jusqu'à l'âge adulte. Les répercussions psychologiques propres à l'enfant en cas de cicatrices pathologiques, et/ou disgracieuses, doivent être prévenues et recherchées par le chirurgien. Children have specific characteristics of wound healing. The aim of this study was to describe the specific clinical characteristics of wounds healing in children and to present the current knowledge on the specific mechanisms with regard to infant age. The tissue insult or injury in fetus can heal without scar, mainly due to reduced granulation tissue associated to diminished or even no inflammatory phase, modified extracellular matrix such as the concentration of hyaluronic acid in amniotic liquid, expression and arrangement of collagen and tenascin. Thickness of children skin is a serious negative factor in case of trauma, whereas poor co-morbidities and efficient growth tissue mechanisms are beneficial to good evolution, even in cases of extensive damage and loss of tissue. The subsequent tissue mechanical forces, wound healing during childhood, spanning from the age of 2 until the end of puberty, is associated with more hypertrophic scars, both in duration and in intensity. Consequently, unnecessary surgery has to be avoided during this period when possible, and children with abnormal or pathologic wound healing should benefit from complementary treatments (hydration, massage, brace, silicone, hydrotherapy…), which represent efficient factors to minimize tissue scarring. After wound healing, the growth body rate can be responsible for specific complications, such as contractures, alopecia, and scar intussusceptions. Its evolutionary character implies the need of an attentive follow-up until adult age. Psychologic repercussions, as a consequence of pathologic scars, must be prevented and investigated by the surgeon.
Source:Annales de Chirurgie Plastique Esthétique
Author(s): J. Sanchez, F. Antonicelli, D. Tuton, S. Mazouz Dorval, C. François
L'enfant présente des critères d'évolution cicatricielle spécifiques. Les objectifs de cet article sont la présentation clinique des particularités de la cicatrisation de l'enfant associée à un état des lieux sur les connaissances des mécanismes fondamentaux expliquant les différences d'évolution selon les âges. L'embryon peut cicatriser sans cicatrice grâce à l'absence de phase inflammatoire (macrophage), l'absence de tissu de granulation, la forte concentration en acide hyaluronique (liquide amniotique, dans la cicatrice), l'agencement et la concentration des collagènes, et à la présence de la ténascine. L'épaisseur cutanée est un facteur péjoratif dans la réparation tissulaire chez l'enfant. En revanche, les faibles comorbidités et les mécanismes physiologiques liés à la croissance sont une aide indéniable à la bonne évolution des plaies de l'enfant. La cicatrisation est souvent très rapide mais peut être explosive. À partir de l'âge de deux ans, l'hypertrophie cicatricielle est majorée, en durée et en intensité. En période pubertaire, les cicatrices hypertrophiques sont plus fréquentes. Tout geste chirurgical non urgent doit être évité durant cette période. Les traitements complémentaires (hydratation, massages, compression, orthèse, silicone, thermalisme…) ont une place importante dans la prise en charge des cicatrices pédiatriques. Après cicatrisation, la croissance peut être responsable de complications spécifiques telles que les brides cicatricielles, l'alopécie, l'invagination cicatricielle. Le caractère évolutif implique la nécessité du suivi jusqu'à l'âge adulte. Les répercussions psychologiques propres à l'enfant en cas de cicatrices pathologiques, et/ou disgracieuses, doivent être prévenues et recherchées par le chirurgien. Children have specific characteristics of wound healing. The aim of this study was to describe the specific clinical characteristics of wounds healing in children and to present the current knowledge on the specific mechanisms with regard to infant age. The tissue insult or injury in fetus can heal without scar, mainly due to reduced granulation tissue associated to diminished or even no inflammatory phase, modified extracellular matrix such as the concentration of hyaluronic acid in amniotic liquid, expression and arrangement of collagen and tenascin. Thickness of children skin is a serious negative factor in case of trauma, whereas poor co-morbidities and efficient growth tissue mechanisms are beneficial to good evolution, even in cases of extensive damage and loss of tissue. The subsequent tissue mechanical forces, wound healing during childhood, spanning from the age of 2 until the end of puberty, is associated with more hypertrophic scars, both in duration and in intensity. Consequently, unnecessary surgery has to be avoided during this period when possible, and children with abnormal or pathologic wound healing should benefit from complementary treatments (hydration, massage, brace, silicone, hydrotherapy…), which represent efficient factors to minimize tissue scarring. After wound healing, the growth body rate can be responsible for specific complications, such as contractures, alopecia, and scar intussusceptions. Its evolutionary character implies the need of an attentive follow-up until adult age. Psychologic repercussions, as a consequence of pathologic scars, must be prevented and investigated by the surgeon.
Tags: Aesthetics
Laser
Skin healing and collagen changes of rats after fractional erbium:yttrium aluminum garnet laser: observation by reflectance confocal microscopy with confirmed histological evidence
Thursday, June 09, 2016, 6:38
Abstract
The fractional erbium:yttrium aluminum garnet (Er:YAG) laser is widely applied. Microstructural changes after laser treatment have been observed with histopathology. Epidermal and dermal microstructures have also been analyzed using reflectance confocal microscopy (RCM). However, no studies have compared these two types of microstructural changes in the same subject at multiple time points after irradiation, and it is unclear if these two types of changes are consistent. We use RCM to observe the effect of different laser energies on skin healing and collagen changes in the skin of Sprague-Dawley rats that had been irradiated by fractional Er:YAG lasering at different energies. RCM was used to observe skin healing and detect collagen changes at different time points. Collagen changes were observed using hematoxylin and eosin (H&E) staining and quantitatively analyzed by western blot. RCM showed that, irrespective of laser energy, microscopic treatment zones (MTZs) were larger at 1 day after irradiation. The MTZs then reduced in size from 3 to 7 days after irradiation. The higher the energy, the larger the MTZ area. The amount of collagen also increased with time from 1 day to 8 weeks. However, the increase in the collagen amount on both RCM and H&E staining was not influenced by the laser energy. Western blotting confirmed that the amount of type I and type III collagens increased over time, but there were no significant differences between the different energy groups (p > 0.05). In conclusion, RCM is a reliable technique for observing and evaluating skin healing and collagen expression after laser irradiation.
Tags: Aesthetics
Plastic, Reconstructive & Aesthetic Surgery
Impact of reduction mammoplasty on the quality of life of obese patients suffering from symptomatic macromastia. A descriptive cohort study
F. Hernanz, M. Fidalgo, P. Muñoz, M. González Noriega, M. Gómez-fleitas · Thursday, June 09, 2016, 4:27
Although reduction mammoplasty is an effective and efficient treatment for symptomatic macromastia, overweight and obese patients who request this treatment are frequently rejected because of selection criteria based on body mass index. Scientific evidence is inconclusive regarding the increased postoperative complications in obese patients undergoing reduction mammoplasty, and there is a lack of adequately designed studies examining the impact of reduction mammoplasty on the quality of life of this group of patients.
Tags: Aesthetics
Plastique Esthétique
Est-il légitime de proposer de la chirurgie esthétique aux enfants et aux adolescents ?
Wednesday, June 08, 2016, 18:54
Publication date: Available online 8 June 2016
Source:Annales de Chirurgie Plastique Esthétique
Author(s): V. Duquennoy-Martinot, N. Aljudaibi, A. Belkhou, C. Depoortère, P. Guerreschi
La chirurgie esthétique des enfants et adolescents connaît un essor international. Leur développement physique et psychique est inachevé ; poser l'indication d'une chirurgie esthétique demande plusieurs prérequis indispensables. Les motivations de la chirurgie, souvent multiples et intriquées, doivent être comprises. Il existe une différence de motivation entre l'adulte, cherchant à être plus « compétitif », et le jeune patient, souhaitant être conforme à un groupe social pour l'intégrer. Il faut cerner de qui émane la demande pour ne répondre qu'aux demandes de l'enfant lui-même. La place des parents est un élément capital. Leur présence, obligation légale, est d'apport variable : atout devant un enfant non participant, rôle de relais de l'information délivrée, organisation pratique des soins mais parfois pourvoyeuse de difficultés si la relation parents–enfant est conflictuelle. Selon l'American Society of Plastic Surgery, 63 623 gestes de chirurgie esthétique ont été réalisés en 2013 chez des adolescents de 13 à 19ans. Principalement des rhinoplasties, otoplasties, chirurgies mammaires (poses de prothèses, réductions mammaires, cures de gynécomasties). Sur le plan strictement technique, la chirurgie esthétique n'est pas plus à risque chez le jeune patient. Cependant la chirurgie ne cible que des « problèmes chirurgicaux » ; il faut distinguer « complexe » et « dépression », savoir dépister une pathologie psychiatrique sous-jacente ou comprendre que la chirurgie est un appel pour un autre problème. Si l'art chirurgical nécessite un réel savoir-faire, il ne donnera de bon résultat que si l'indication est bien posée. Cosmetic surgery for children and adolescents experiencing an international increase. Their physical and psychological development is incomplete; establishment of an indication for cosmetic surgery requires several essential prerequisites. The motivations of surgery, often multiple and intricate, must be understood. There is a difference in motivation between adult, trying to be more "competitive" and the young patient, wishing to comply with a social group to integrate. We must identify who made the request to respond to requests from the child himself. The role of parents is crucial. Their presence, legal obligation, gives variable contribution: asset to a non-participating children, role of information relay delivered, organizational aspects of care but sometimes leads to difficulties if parent–child relationship is confrontational. According to the American Society of Plastic Surgery, 63,623 cosmetic surgery procedures occurred in 2013 in adolescents from 13 to 19 years old. Mainly rhinoplasties, otoplasties, breast surgery (breast augmentations, breast reductions, gynecomasties). From a purely technical viewpoint, cosmetic surgery is not riskier in young patients. However, surgery only targets "surgical problems"; we must make a distinction between "complex" and "depression", be able to identify a psychiatric underlying disease or understand that surgery is a hidden demand. If surgical art requires a real expertise, only a well-indication establishment will process to a successful result.
Source:Annales de Chirurgie Plastique Esthétique
Author(s): V. Duquennoy-Martinot, N. Aljudaibi, A. Belkhou, C. Depoortère, P. Guerreschi
La chirurgie esthétique des enfants et adolescents connaît un essor international. Leur développement physique et psychique est inachevé ; poser l'indication d'une chirurgie esthétique demande plusieurs prérequis indispensables. Les motivations de la chirurgie, souvent multiples et intriquées, doivent être comprises. Il existe une différence de motivation entre l'adulte, cherchant à être plus « compétitif », et le jeune patient, souhaitant être conforme à un groupe social pour l'intégrer. Il faut cerner de qui émane la demande pour ne répondre qu'aux demandes de l'enfant lui-même. La place des parents est un élément capital. Leur présence, obligation légale, est d'apport variable : atout devant un enfant non participant, rôle de relais de l'information délivrée, organisation pratique des soins mais parfois pourvoyeuse de difficultés si la relation parents–enfant est conflictuelle. Selon l'American Society of Plastic Surgery, 63 623 gestes de chirurgie esthétique ont été réalisés en 2013 chez des adolescents de 13 à 19ans. Principalement des rhinoplasties, otoplasties, chirurgies mammaires (poses de prothèses, réductions mammaires, cures de gynécomasties). Sur le plan strictement technique, la chirurgie esthétique n'est pas plus à risque chez le jeune patient. Cependant la chirurgie ne cible que des « problèmes chirurgicaux » ; il faut distinguer « complexe » et « dépression », savoir dépister une pathologie psychiatrique sous-jacente ou comprendre que la chirurgie est un appel pour un autre problème. Si l'art chirurgical nécessite un réel savoir-faire, il ne donnera de bon résultat que si l'indication est bien posée. Cosmetic surgery for children and adolescents experiencing an international increase. Their physical and psychological development is incomplete; establishment of an indication for cosmetic surgery requires several essential prerequisites. The motivations of surgery, often multiple and intricate, must be understood. There is a difference in motivation between adult, trying to be more "competitive" and the young patient, wishing to comply with a social group to integrate. We must identify who made the request to respond to requests from the child himself. The role of parents is crucial. Their presence, legal obligation, gives variable contribution: asset to a non-participating children, role of information relay delivered, organizational aspects of care but sometimes leads to difficulties if parent–child relationship is confrontational. According to the American Society of Plastic Surgery, 63,623 cosmetic surgery procedures occurred in 2013 in adolescents from 13 to 19 years old. Mainly rhinoplasties, otoplasties, breast surgery (breast augmentations, breast reductions, gynecomasties). From a purely technical viewpoint, cosmetic surgery is not riskier in young patients. However, surgery only targets "surgical problems"; we must make a distinction between "complex" and "depression", be able to identify a psychiatric underlying disease or understand that surgery is a hidden demand. If surgical art requires a real expertise, only a well-indication establishment will process to a successful result.
Tags: Aesthetics
Plastique Esthétique
Cure d'oreilles décollées
Wednesday, June 08, 2016, 18:54
Publication date: Available online 8 June 2016
Source:Annales de Chirurgie Plastique Esthétique
Author(s): J. Ellart, P. Guerreschi, L. Pasquesoone, V. Duquennoy-Martinot
Les oreilles décollées constituent une disgrâce qui est un motif fréquent de consultation en chirurgie plastique en particulier chez l'enfant. En effet, elle est souvent l'objet de moqueries et de remarques désobligeantes qui engendrent dans certains cas des difficultés psychologiques ou des conflits scolaires. Les oreilles décollées sont la résultante d'une ou plusieurs anomalies congénitales qui peuvent s'associer entre elles à des degrés divers. Le défaut de plicature de l'anthélix, l'ouverture de l'angle céphaloconchal et l'hypertrophie de conque sont les plus fréquentes. La chirurgie vise à corriger ces anomalies, en remodelant le cartilage de façon à obtenir des oreilles bien plicaturées, normalement positionnées et orientées, symétriques, de taille et d'aspect naturels. Elle combine différents gestes qui doivent être simples et rapides. L'incision est rétro-auriculaire, la dissection jusqu'au plan mastoïdien permet de repérer le muscle rétro-auriculaire qui est ôté. Le modelage de l'anthélix vise à lui redonner un relief naturel par fermeture de l'angle scaphoconchal. La conque est ensuite enfouie et est amarrée solidement au périoste pré-mastoïdien, ce qui a pour conséquence de fermer l'angle céphaloconchal. Le résultat doit être harmonieux et durable. Chaque chirurgien adopte une technique qui lui est propre en s'adaptant au cas par cas pour obtenir le meilleur résultat, en évitant les complications dominées par le risque d'infection heureusement exceptionnelle. Prominent ears can have a significant psychological impact especially in children. It is often the subject of negative remarks among classmates. Prominent ears are the result of one or more congenital anomalies that may be associated together in various degrees. Absence of antihelical fold, opening the cephalo-conchal angle and conchal hypertrophy are the most common. The surgery aims to correct these anomalies, by reshaping the cartilage in order to obtain well-shaped ears that is normally positioned and oriented with natural size and appearance. It combines different steps that need to be simple and fast. Retro-auricular incision, and dissection posteriorly allows to expose and remove the post-auricular muscle. Modeling of antihelical fold aims to restore a natural relief by closing the scapha-conchal angle. The concha is then buried and is securely attached to the pre-mastoid periosteum, which by consequence closes cephalo-conchal angle. The result must be harmonious and sustainable. Each surgeon adopts a suitable technique for him to obtain best results, by avoiding complications mainly infection, which is fortunately exceptional.
Source:Annales de Chirurgie Plastique Esthétique
Author(s): J. Ellart, P. Guerreschi, L. Pasquesoone, V. Duquennoy-Martinot
Les oreilles décollées constituent une disgrâce qui est un motif fréquent de consultation en chirurgie plastique en particulier chez l'enfant. En effet, elle est souvent l'objet de moqueries et de remarques désobligeantes qui engendrent dans certains cas des difficultés psychologiques ou des conflits scolaires. Les oreilles décollées sont la résultante d'une ou plusieurs anomalies congénitales qui peuvent s'associer entre elles à des degrés divers. Le défaut de plicature de l'anthélix, l'ouverture de l'angle céphaloconchal et l'hypertrophie de conque sont les plus fréquentes. La chirurgie vise à corriger ces anomalies, en remodelant le cartilage de façon à obtenir des oreilles bien plicaturées, normalement positionnées et orientées, symétriques, de taille et d'aspect naturels. Elle combine différents gestes qui doivent être simples et rapides. L'incision est rétro-auriculaire, la dissection jusqu'au plan mastoïdien permet de repérer le muscle rétro-auriculaire qui est ôté. Le modelage de l'anthélix vise à lui redonner un relief naturel par fermeture de l'angle scaphoconchal. La conque est ensuite enfouie et est amarrée solidement au périoste pré-mastoïdien, ce qui a pour conséquence de fermer l'angle céphaloconchal. Le résultat doit être harmonieux et durable. Chaque chirurgien adopte une technique qui lui est propre en s'adaptant au cas par cas pour obtenir le meilleur résultat, en évitant les complications dominées par le risque d'infection heureusement exceptionnelle. Prominent ears can have a significant psychological impact especially in children. It is often the subject of negative remarks among classmates. Prominent ears are the result of one or more congenital anomalies that may be associated together in various degrees. Absence of antihelical fold, opening the cephalo-conchal angle and conchal hypertrophy are the most common. The surgery aims to correct these anomalies, by reshaping the cartilage in order to obtain well-shaped ears that is normally positioned and oriented with natural size and appearance. It combines different steps that need to be simple and fast. Retro-auricular incision, and dissection posteriorly allows to expose and remove the post-auricular muscle. Modeling of antihelical fold aims to restore a natural relief by closing the scapha-conchal angle. The concha is then buried and is securely attached to the pre-mastoid periosteum, which by consequence closes cephalo-conchal angle. The result must be harmonious and sustainable. Each surgeon adopts a suitable technique for him to obtain best results, by avoiding complications mainly infection, which is fortunately exceptional.
Tags: Aesthetics
Plastique Esthétique
L'ombilic chez l'enfant
Wednesday, June 08, 2016, 18:54
Publication date: Available online 8 June 2016
Source:Annales de Chirurgie Plastique Esthétique
Author(s): L. Jayyosi, N. Boudaoud, O. Okiemy, N. Correia, E. Alanio-Detton, J.P. Bory, A. Liné, M.L. Poli-Merol, S. Mazouz Dorval, C. Francois
L'ombilic est notre première cicatrice. C'est le reliquat de notre vie intra-utérine. À côté de la hernie ombilicale qui est une pathologie fréquente et rarement chirurgicale durant les trois premières années de vie, il existe des anomalies congénitales rares, 1–5/10 000 naissances, telles que le laparoschisis et l'omphalocèle. Le laparoschisis, éviscération non couverte à travers un defect para-ombilical droit, est diagnostiqué en anténatal dès la 13e semaine. Le cordon est normalement inséré et l'intestin flotte librement dans le liquide amniotique. Le terrain de prédilection est la femme jeune, tabagique et/ou cocaïnomane. L'association à des maladies génétiques est exceptionnelle. L'omphalocèle est quant à elle, une cœlosomie ventrale moyenne correspondant à une hernie médiane des viscères à travers l'orifice ombilical. De diagnostic anténatal, le terrain de prédilection est l'âge maternel avancé. Les anomalies associées morphologiques et génétiques sont fréquentes. Un caryotype est systématiquement réalisé. Pour ces deux pathologies la problématique chirurgicale réside en la gestion du conflit contenant/contenu responsable d'un syndrome cave inférieur et de troubles ventilatoires à la réintégration. Le choix de la technique dépendra de la forme clinique et de la tolérance à la réintégration. La réussite chirurgicale initiale est directement liée à la prise en charge réanimatoire pré-, per-, et post-natal. Le cordon ombilical présent en cas de laparoschisis est conservé. Dans l'omphalocèle une ombilicoplastie primaire ou secondaire sera réalisée. L'ombilicoplastie a pour objectif de créer un nombril en bonne position en donnant une forme, idéalement d'ovale à ce dernier, mais aussi et surtout une ombilication. L'ombilicoplastie primaire ou secondaire reste un challenge sur un abdomen en croissance (modification de la position, déformation, perte de l'invagination avec la croissance). De nombreuses techniques sont décrites : lambeaux cutanés au hasard, exérèses et plasties cutanés, exérèses et cicatrisation dirigée. Le choix de la technique est question d'école mais devra se faire de manière raisonnée, en fonction de l'état cicatriciel en cas de reconstruction secondaire, et en limitant au maximum la rançon cicatricielle, en cas de reconstruction primaire. Afin d'éviter au maximum les modifications morphologiques liées à la croissance l'ombilicoplastie secondaire devrait être proposée après l'âge de cinq ans. The umbilicus is our first scar. It is the last remain of our life in utero. Besides the umbilical hernia, a common pathology during the first three years of life that rarely requires surgery, there are some rare congenital abnormalities such as gastroschisis and omphalocele, which occur in about 1–5/10,000 births. Gastroschisis is a birth defect of the anterior abdominal wall, through which the fetal intestines freely protrude and are not covered by any membranes. During the 13th week prenatal ultrasound, the umbilical cord can be seen to be properly attached while the intestines float freely in the amniotic fluid. This defect is most common in young women who smoke and/or use cocaine and is not typically associated with genetic disorders. Omphalocele is an average coelosomy, in which a visceral hernia protrudes into the base of the umbilical cord. Omphalocele is typically diagnosed during the prenatal phase, and occurs most commonly in older mothers. It is frequently associated with genetic and morphologic abnormalities, therefore a karyotype should automatically be performed. For these two pathologies, the surgical problem lies in managing, during the reintegration, the conflict container/content responsible to lower vena cava syndrome and disorders ventilatory. Deciding on the technique will depend on the clinical form, and on the tolerance to reinsertion. The success of the surgery is directly linked to the postoperative emergence care for the pre-, per- and postnatal phases. The umbilical cord is preserved in the case of a gastroschisis. A primary or secondary umbilicoplasty will be performed for an omphalocele closure. The umbilicoplasty aims to create an umbilicus in a good position by giving it a shape, ideally oval, but also and especially an umbilication. The primary or secondary umbilicoplasty remains a challenge in a growing abdomen (change in position, deformation, loss of intussusception with growth). Many techniques are described: cutaneous flaps randomly placed, excision and skin plasty, resection and controlled wound healing. The choice of technique is a matter of practice but must be done in a rational way, depending on the scar condition when secondary reconstruction, and with minimal scarring, for primary reconstruction. To avoid morphological changes associated with growth, secondary umbilicoplasty should be proposed after the age of five.
Source:Annales de Chirurgie Plastique Esthétique
Author(s): L. Jayyosi, N. Boudaoud, O. Okiemy, N. Correia, E. Alanio-Detton, J.P. Bory, A. Liné, M.L. Poli-Merol, S. Mazouz Dorval, C. Francois
L'ombilic est notre première cicatrice. C'est le reliquat de notre vie intra-utérine. À côté de la hernie ombilicale qui est une pathologie fréquente et rarement chirurgicale durant les trois premières années de vie, il existe des anomalies congénitales rares, 1–5/10 000 naissances, telles que le laparoschisis et l'omphalocèle. Le laparoschisis, éviscération non couverte à travers un defect para-ombilical droit, est diagnostiqué en anténatal dès la 13e semaine. Le cordon est normalement inséré et l'intestin flotte librement dans le liquide amniotique. Le terrain de prédilection est la femme jeune, tabagique et/ou cocaïnomane. L'association à des maladies génétiques est exceptionnelle. L'omphalocèle est quant à elle, une cœlosomie ventrale moyenne correspondant à une hernie médiane des viscères à travers l'orifice ombilical. De diagnostic anténatal, le terrain de prédilection est l'âge maternel avancé. Les anomalies associées morphologiques et génétiques sont fréquentes. Un caryotype est systématiquement réalisé. Pour ces deux pathologies la problématique chirurgicale réside en la gestion du conflit contenant/contenu responsable d'un syndrome cave inférieur et de troubles ventilatoires à la réintégration. Le choix de la technique dépendra de la forme clinique et de la tolérance à la réintégration. La réussite chirurgicale initiale est directement liée à la prise en charge réanimatoire pré-, per-, et post-natal. Le cordon ombilical présent en cas de laparoschisis est conservé. Dans l'omphalocèle une ombilicoplastie primaire ou secondaire sera réalisée. L'ombilicoplastie a pour objectif de créer un nombril en bonne position en donnant une forme, idéalement d'ovale à ce dernier, mais aussi et surtout une ombilication. L'ombilicoplastie primaire ou secondaire reste un challenge sur un abdomen en croissance (modification de la position, déformation, perte de l'invagination avec la croissance). De nombreuses techniques sont décrites : lambeaux cutanés au hasard, exérèses et plasties cutanés, exérèses et cicatrisation dirigée. Le choix de la technique est question d'école mais devra se faire de manière raisonnée, en fonction de l'état cicatriciel en cas de reconstruction secondaire, et en limitant au maximum la rançon cicatricielle, en cas de reconstruction primaire. Afin d'éviter au maximum les modifications morphologiques liées à la croissance l'ombilicoplastie secondaire devrait être proposée après l'âge de cinq ans. The umbilicus is our first scar. It is the last remain of our life in utero. Besides the umbilical hernia, a common pathology during the first three years of life that rarely requires surgery, there are some rare congenital abnormalities such as gastroschisis and omphalocele, which occur in about 1–5/10,000 births. Gastroschisis is a birth defect of the anterior abdominal wall, through which the fetal intestines freely protrude and are not covered by any membranes. During the 13th week prenatal ultrasound, the umbilical cord can be seen to be properly attached while the intestines float freely in the amniotic fluid. This defect is most common in young women who smoke and/or use cocaine and is not typically associated with genetic disorders. Omphalocele is an average coelosomy, in which a visceral hernia protrudes into the base of the umbilical cord. Omphalocele is typically diagnosed during the prenatal phase, and occurs most commonly in older mothers. It is frequently associated with genetic and morphologic abnormalities, therefore a karyotype should automatically be performed. For these two pathologies, the surgical problem lies in managing, during the reintegration, the conflict container/content responsible to lower vena cava syndrome and disorders ventilatory. Deciding on the technique will depend on the clinical form, and on the tolerance to reinsertion. The success of the surgery is directly linked to the postoperative emergence care for the pre-, per- and postnatal phases. The umbilical cord is preserved in the case of a gastroschisis. A primary or secondary umbilicoplasty will be performed for an omphalocele closure. The umbilicoplasty aims to create an umbilicus in a good position by giving it a shape, ideally oval, but also and especially an umbilication. The primary or secondary umbilicoplasty remains a challenge in a growing abdomen (change in position, deformation, loss of intussusception with growth). Many techniques are described: cutaneous flaps randomly placed, excision and skin plasty, resection and controlled wound healing. The choice of technique is a matter of practice but must be done in a rational way, depending on the scar condition when secondary reconstruction, and with minimal scarring, for primary reconstruction. To avoid morphological changes associated with growth, secondary umbilicoplasty should be proposed after the age of five.
Tags: Aesthetics
Plastique Esthétique
Prise en charge des lésions des parties molles du purpura fulminans chez l'enfant
Wednesday, June 08, 2016, 18:54
Publication date: Available online 8 June 2016
Source:Annales de Chirurgie Plastique Esthétique
Author(s): L. Pasquesoone, A. Belkhou, L. Gottrand, P. Guerreschi, V. Duquennoy-Martinot
Le purpura fulminans est une urgence vitale pédiatrique à la mortalité élevée associant : état de choc septique, lésions purpuriques extensives et coagulation intravasculaire disséminée. Le méningocoque est l'agent bactérien le plus souvent responsable. Le traitement médical repose sur l'antibiothérapie, la corticothérapie, le remplissage vasculaire et les catécholamines. Le purpura fulminans se distingue par l'importance des lésions hémorragiques et surtout thrombotiques liées aux altérations des fonctions de l'endothélium vasculaire. L'atteinte des parties molles associe de larges placards nécrotiques à des lésions d'ischémie distale plus ou moins étendues. Les nécroses peuvent être profondes, touchant la peau, le tissu sous-cutané, le fascia, le muscle et parfois même l'os. La qualité de la prise en charge chirurgicale de ces lésions étendues et profondes conditionne l'importance des séquelles esthétiques, fonctionnelles et la qualité de vie future. Des fasciotomies sont parfois nécessaires en urgence en cas de syndrome des loges clinique, confirmé par des mesures élevées des pressions des loges musculaires. Le parage des lésions nécrotiques et les amputations ne sont réalisés qu'après délimitation nette des nécroses entre dix jours et trois semaines d'évolution. Quand l'amputation est indispensable, elle privilégie au maximum la longueur osseuse résiduelle en considérant le potentiel de croissance de l'enfant. La couverture des pertes de substance associe toutes les techniques de chirurgie plastique plus ou moins complexes, s'évertuant à diminuer au maximum la rançon cicatricielle chez ces enfants. Le suivi rééducatif associe prise en charge physique et suivi psychologique indispensable jusqu'à l'âge adulte. Purpura fulminans is a pediatric life-threatening emergency with a significant mortality, combining: septic shock, extensive purpuric lesions and disseminated intravascular coagulation. The most frequent bacterial pathogen is the meningococcus. The medical management includes antibiotics, corticoids, vascular filling and catecholamines. Purpura fulminans is characterized by the extent of hemorrhagic and mainly thrombotic lesions, attributed to the alteration in the vascular endothelium functions. Damage of soft tissues combines large necrotic areas and more or less extensive distal ischemic lesions. Necrotic lesions can be deep, reaching skin, subcutaneous tissue, fascia, muscle and sometimes even the bone. The importance of the aesthetic and functional sequelae as well as future quality of life, depend on the quality of surgical management for these wide and deep lesions. Fasciotomy is sometimes urgently needed in the case of a clinical compartment syndrome, confirmed by a high-pressure measurement in the muscle compartments. Debridement of necrotic lesions and amputations are only performed after a clear delineation of necrotic areas, between 10 days and 3 weeks of evolution. If an amputation is necessary, it must focus on the residual bone length, considering the child's growth potential. The coverage of tissue loss uses all the plastic surgery techniques, more or less complex, in order to reduce scars to minimum for these children. Rehabilitation follow-up includes physical and psychological care, which are essential until adulthood.
Source:Annales de Chirurgie Plastique Esthétique
Author(s): L. Pasquesoone, A. Belkhou, L. Gottrand, P. Guerreschi, V. Duquennoy-Martinot
Le purpura fulminans est une urgence vitale pédiatrique à la mortalité élevée associant : état de choc septique, lésions purpuriques extensives et coagulation intravasculaire disséminée. Le méningocoque est l'agent bactérien le plus souvent responsable. Le traitement médical repose sur l'antibiothérapie, la corticothérapie, le remplissage vasculaire et les catécholamines. Le purpura fulminans se distingue par l'importance des lésions hémorragiques et surtout thrombotiques liées aux altérations des fonctions de l'endothélium vasculaire. L'atteinte des parties molles associe de larges placards nécrotiques à des lésions d'ischémie distale plus ou moins étendues. Les nécroses peuvent être profondes, touchant la peau, le tissu sous-cutané, le fascia, le muscle et parfois même l'os. La qualité de la prise en charge chirurgicale de ces lésions étendues et profondes conditionne l'importance des séquelles esthétiques, fonctionnelles et la qualité de vie future. Des fasciotomies sont parfois nécessaires en urgence en cas de syndrome des loges clinique, confirmé par des mesures élevées des pressions des loges musculaires. Le parage des lésions nécrotiques et les amputations ne sont réalisés qu'après délimitation nette des nécroses entre dix jours et trois semaines d'évolution. Quand l'amputation est indispensable, elle privilégie au maximum la longueur osseuse résiduelle en considérant le potentiel de croissance de l'enfant. La couverture des pertes de substance associe toutes les techniques de chirurgie plastique plus ou moins complexes, s'évertuant à diminuer au maximum la rançon cicatricielle chez ces enfants. Le suivi rééducatif associe prise en charge physique et suivi psychologique indispensable jusqu'à l'âge adulte. Purpura fulminans is a pediatric life-threatening emergency with a significant mortality, combining: septic shock, extensive purpuric lesions and disseminated intravascular coagulation. The most frequent bacterial pathogen is the meningococcus. The medical management includes antibiotics, corticoids, vascular filling and catecholamines. Purpura fulminans is characterized by the extent of hemorrhagic and mainly thrombotic lesions, attributed to the alteration in the vascular endothelium functions. Damage of soft tissues combines large necrotic areas and more or less extensive distal ischemic lesions. Necrotic lesions can be deep, reaching skin, subcutaneous tissue, fascia, muscle and sometimes even the bone. The importance of the aesthetic and functional sequelae as well as future quality of life, depend on the quality of surgical management for these wide and deep lesions. Fasciotomy is sometimes urgently needed in the case of a clinical compartment syndrome, confirmed by a high-pressure measurement in the muscle compartments. Debridement of necrotic lesions and amputations are only performed after a clear delineation of necrotic areas, between 10 days and 3 weeks of evolution. If an amputation is necessary, it must focus on the residual bone length, considering the child's growth potential. The coverage of tissue loss uses all the plastic surgery techniques, more or less complex, in order to reduce scars to minimum for these children. Rehabilitation follow-up includes physical and psychological care, which are essential until adulthood.
Tags: Aesthetics
Plastique Esthétique
Les complications de l'expansion cutanée en pédiatrie : diagnostic, prise en charge et prévention
Wednesday, June 08, 2016, 18:54
Publication date: Available online 8 June 2016
Source:Annales de Chirurgie Plastique Esthétique
Author(s): S. Pascal, C. Philandrianos, B. Bertrand, J. Bardot, N. Degardin, D. Casanova
L'expansion cutanée est un processus long et délicat au cours duquel peuvent apparaître des complications plus ou moins graves. Les données de la littérature retrouvent un taux global de complications variable allant de 13 à 37 %. Nous pouvons les classer en complications majeures pouvant aboutir à un échec du traitement voire à une aggravation de l'état antérieur et en complications mineures ne compromettant pas le protocole d'expansion mais pouvant le modifier. Les principales complications majeures sont l'infection, la souffrance cutanée et la nécrose pouvant aboutir à l'exposition de la prothèse, les fuites et les problèmes techniques avec dysfonction du matériel engendrant des difficultés et parfois même un échec des gonflages. Les principales complications mineures sont les hématomes et les séromes, l'exposition de la valve ou de la tubulure, les douleurs avec paresthésies par compression des organes de voisinage, les cicatrices pathologiques et inesthétique et un retentissement psychologique important. Ces complications peuvent résulter d'un état cutané précaire, d'un dysfonctionnement de matériel ou de problèmes techniques inhérents à la procédure mais également être liées à une mauvaise indication ou planification préopératoire. L'apparition d'une complication n'est cependant pas synonyme d'échec de la procédure ; une reconstruction satisfaisante peut-être tout de même obtenue dans près de ¾ des cas. Cet article a pour but d'aider à identifier les situations à risque de complications afin de pouvoir les prévenir, les dépister et les prendre en charge précocement. Skin expansion is a difficult and long process in which can occur more or less serious complications. Overall complications rates describe in the literature vary between 13 and 37%. We can categorize them in major complications, which can lead to a failure maybe even an aggravation of the anterior status, and in minor complications that do not compromise the expansion process but can alter it. The main major complications are infection, skin suffering and necrosis which can lead to prosthesis exposition, leaks and technical problems with equipment dysfunctions that may cause difficulties or a failure of the inflations. The main minor complications are hematomas, seromas, valve or tube exposition, pains with paraesthesias caused by neighbouring organs compression, pathologic and unsightly scares and can lead to an important psychological impact. These complications can be due to a precarious skin's state, a material dysfunction or unpredictable technical problems but also by an inappropriate preoperative indication or planning. The emerging of a complication, however, is not synonymous to a failure of the procedure; a satisfactory reconstruction may still be obtained in 75% of all cases. The purpose of this article is to help to identify the situations at risk of complications in order to prevent, detect and treat them early.
Source:Annales de Chirurgie Plastique Esthétique
Author(s): S. Pascal, C. Philandrianos, B. Bertrand, J. Bardot, N. Degardin, D. Casanova
L'expansion cutanée est un processus long et délicat au cours duquel peuvent apparaître des complications plus ou moins graves. Les données de la littérature retrouvent un taux global de complications variable allant de 13 à 37 %. Nous pouvons les classer en complications majeures pouvant aboutir à un échec du traitement voire à une aggravation de l'état antérieur et en complications mineures ne compromettant pas le protocole d'expansion mais pouvant le modifier. Les principales complications majeures sont l'infection, la souffrance cutanée et la nécrose pouvant aboutir à l'exposition de la prothèse, les fuites et les problèmes techniques avec dysfonction du matériel engendrant des difficultés et parfois même un échec des gonflages. Les principales complications mineures sont les hématomes et les séromes, l'exposition de la valve ou de la tubulure, les douleurs avec paresthésies par compression des organes de voisinage, les cicatrices pathologiques et inesthétique et un retentissement psychologique important. Ces complications peuvent résulter d'un état cutané précaire, d'un dysfonctionnement de matériel ou de problèmes techniques inhérents à la procédure mais également être liées à une mauvaise indication ou planification préopératoire. L'apparition d'une complication n'est cependant pas synonyme d'échec de la procédure ; une reconstruction satisfaisante peut-être tout de même obtenue dans près de ¾ des cas. Cet article a pour but d'aider à identifier les situations à risque de complications afin de pouvoir les prévenir, les dépister et les prendre en charge précocement. Skin expansion is a difficult and long process in which can occur more or less serious complications. Overall complications rates describe in the literature vary between 13 and 37%. We can categorize them in major complications, which can lead to a failure maybe even an aggravation of the anterior status, and in minor complications that do not compromise the expansion process but can alter it. The main major complications are infection, skin suffering and necrosis which can lead to prosthesis exposition, leaks and technical problems with equipment dysfunctions that may cause difficulties or a failure of the inflations. The main minor complications are hematomas, seromas, valve or tube exposition, pains with paraesthesias caused by neighbouring organs compression, pathologic and unsightly scares and can lead to an important psychological impact. These complications can be due to a precarious skin's state, a material dysfunction or unpredictable technical problems but also by an inappropriate preoperative indication or planning. The emerging of a complication, however, is not synonymous to a failure of the procedure; a satisfactory reconstruction may still be obtained in 75% of all cases. The purpose of this article is to help to identify the situations at risk of complications in order to prevent, detect and treat them early.
Tags: Aesthetics
Plastic, Reconstructive & Aesthetic Surgery
Toxic epidermal necrolysis: The past, the guidelines and challenges for the future
Pierre Wolkenstein, Yvonne T. Wilson · Wednesday, June 08, 2016, 12:26
Toxic epidermal necrolysis (TEN) is one of the most extraordinary diseases that dermatologists face in terms of morbidity, mortality and sequelae. It has also been a major challenge for research to elucidate its mechanisms. It is more than an acute skin failure; it is a systemic disease that requires a multidisciplinary approach. This challenge has been taken up and resulted in collaboration between dermatologists, plastic surgeons, burn surgeons, intensivists and other specialists. Indeed, during the past decade, major advances have been made in diagnosing Stevens-Johnson syndrome (SJS) and TEN, managing their manifestations and identifying both their pathogenesis and at-risk populations.
Tags: Aesthetics
Plastic, Reconstructive & Aesthetic Surgery
The future of plastic surgery data collection, analysis and presentation
M. Felix Freshwater · Wednesday, June 08, 2016, 12:26
It should not surprise readers across the pond to learn that just as Hollywood regularly produces sequels to horror movies, e.g., Jaws IV or Friday the 13th part 13, so too do horror stories recur in the press for products that we use such as silicone gel filled implants.1 You also should not be surprised that Annals of Internal Medicine is not on the list "Journals Regularly Read by American Plastic Surgeons."
Tags: Aesthetics
Plastic, Reconstructive & Aesthetic Surgery
UK guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in adults 2016
D. Creamer, S.a. Walsh, P. Dziewulski, L.s. Exton, H.y. Lee, J.k.g. Dart, J. Setterfield, C.b. Bunker, M.r. Ardern-jones, K.m.t. Watson, G.a.e. Wong, M. Philippidou, A. Vercueil, R.v. Martin, G. Williams, M. Shah, D. Brown, P. Williams, M.f. Mohd Mustapa, C.h. Smith ·Wednesday, June 08, 2016, 12:26
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the diagnosis and management of the full spectrum of Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS-TEN overlap in adults during the acute phase of the disease.The document aims to:
Tags: Aesthetics
Laser
Low-level phototherapy to improve exercise capacity and muscle performance: a systematic review and meta-analysis
Wednesday, June 08, 2016, 6:37
Abstract
The aim of this study was to evaluate the effectiveness of pre-exercise low-level phototherapy (Light-Emitting Diode therapy [LEDtherapy] or Light Amplification by Stimulate Emission of Radiation therapy [LASERtherapy]) in increasing exercise capacity and muscle performance of people undergoing exercise when compared to placebo treatment. Randomized controlled trials and crossover studies were sought on CENTRAL, MEDLINE, EMBASE, SciELO, PEDro and LILACS from its inception up to February 2015. References lists of included studies were sought for additional relevant research. Two authors independently extracted data on study design, treatment parameters, exercise capacity (number of repetitions, time to exhaustion, blood lactate concentration and lactate dehydrogenase activity) and muscle performance (torque, power and strength) using an structured table. Agreement should be reached by consensus or by a third reviewer. Sixteen studies involving 297 participants were included. Improvement of number of repetitions (mean difference [MD] [95 % confidence interval] = 3.51 repetitions [0.65–6.37]; P = 0.02), delay in time to exhaustion (MD = 4.01 s [2.10–5.91]; P < 0.0001), reduction in lactate levels (MD = 0.34 mmol/L [0.19–0.48]; P < 0.00001) and increased peak torque (MD = 21.51 Nm [10.01–33.01]; P < 0.00001) were observed when LASERtherapy was applied. LEDtherapy meta-analyses were performed with two studies and retrieved no between-group statistically significant difference in power, lactate levels or time to exhaustion. Although our results suggest that LASERtherapy is effective in improving skeletal muscle exercise capacity, the quality of the current evidence is limited.
Tags: Aesthetics
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