Introduction: Because of the important anatomical structures situated superficially, reconstruction of wrist soft tissue defects is challenging for the plastic surgeon. Depending on the characteristics of the defect, various reconstruction methods are commonly performed. A pedicled perforator flap stands as a valuable option providing reliable coverage of the defect while preserving the vascularity. Case report: A 35-year-old male presented with a post traumatic wrist soft tissue defect with exposure of underlying structures. Surgical debridement was performed, and the resulting defect was reconstructed with a distally-based radial artery pedicled perforator flap. Postoperative recovery was uncomplicated. Conclusion: Radial artery perforator flap proved to be a workhorse flap for soft tissue reconstruction of the wrist. It has many of the benefits of the radial forearm flap but minimizes the disadvantages.

The forehead, a vital anatomical unit of the face, is delimited by the anterior hairline superiorly and by the nasal root, eyebrows, and a horizontal line through the lateral canthus inferiorly. Malignant tumors like basal cell carcinomas frequently afflict this region, necessitating meticulous reconstruction techniques to preserve aesthetics and functionality. This article presents an in-depth exploration of the galea flap graft’s efficacy in addressing tissue defect on the forehead, especially in cases of basal cell carcinomas. The surgical procedure involves a wide excision with a 1 cm safety margin, including the frontal muscle and periosteum, followed by exposing the frontal bone. A meticulous approach is taken in tracing the midline, marking the hairline, and planning the left hemi coronal incision to ensure optimal outcomes. The galea flap, vascularized by branches of the superficial temporal artery, is meticulously lifted and transposed downwards to cover the tissue defect, while ensuring the viability of the flap. Postoperative monitoring reveals no signs of cutaneous or vascular damage, with preserved sensory and motor functions attributed to the preservation of the frontal branch of the facial nerve. The discussion delves into the intricate anatomy of the forehead, emphasizing its vascularization, innvervation, and aesthetic subunits such as the glabella and eyebrows. Various surgical techniques, including direct suturing, directed healing, skin grafts, advancement flaps, and two-stage scalp flaps, are examined in light of their efficacy and limitations in forehead reconstruction. The galea flap emerges as a preferred option due to its reliable vascular supply, ease of lifting, and versatility in covering tissue defects while preserving aesthetics. Future research directions are suggested, focusing on refining surgical techniques to achieve optimal outcomes in forehead tissue reconstruction, balancing esthetic results with functional integrit.

Les brulures de la main sont tres frequentes. Estimees a 47,1% de l’ensemble des brulures, elles representent le plus souvent un probleme local. Ces brulures sont dans 90 % d’origine thermique et dans 10% d’origine electrique ou chimique. Elles revetent differents aspects cliniques selon la profondeur de la brulure. La prise en charge therapeutique medicochirurgicale vise en premier a juguler l’urgence du syndrome des loges et des compressions mecaniques qui sont dans notre contexte de diagnostic clinique. Dans un second temps, elle vise a retablir une couverture cutanee par le plus souvent une excision greffe precoce avant le cinquieme jour et a maintenir une bonne fonction de la main par une reeducation adaptee. Cette bonne conduite therapeutique permet de restituer a la main toute sa valeur fonctionnelle et esthetique.

Introduction : Appelee gynecomastie l’hyperplasie uni- ou bilaterale, non tumorale de la glande mammaire, est observee chez l’adolescent ou adulte avec un retentissement psychologique important. Pathologie frequente qui necessite toujours un bilan etiologique avant d’entreprendre un traitement chirurgical. La mastectomie par voie peri areolaire et la liposuccion sont souvent associees dans son traitement chirurgical. Il faut respecter la position propre au thorax masculin a savoir la position des areoles. Patients et methodes : Quinze patients ont opere dans le service dans la periode allant de janvier 2006 a decembre 2011, on a observe 3 cas unilateraux avec 12 cas bilateraux et la moyenne d’âge etait de 32 ans (22 a 47 ans). Resultats : L’aspect inesthetique est observe chez tous les patients. La mastodynie est observee chez trois patients avec crainte du cancer du sein chez un patient. La classification des Gynecomasties au grade II bilateraux est la plus frequente. L’echo-mammographie a ete realisee chez tous les patients et est revenue normale Le bilan hormonal usuel est le dosage de la Testosterone, de l’Oestradiol, de la LH et l’FSH ainsi que le bilan hepatique. Les echographies testiculaires et abdominales sont normales. Lorsque la gynecomastie idiopathique a ete observee, le bilan etiologique etait negatif chez tous ses patients. Discussion : La gynecomastie est frequente observee chez 35 % des adultes. Les etiologies les plus frequentes sont les gynecomasties para-pubertaires, les gynecomasties acquises a l’âge adulte, et d’autres etiologies aussi impliquees tel que l’hypogonadisme, l’insuffisance hepatique et renale, l’hyperthyroidie, l’ambiguite sexuelle. Conclusion : Les gynecomasties sont un motif frequent de consultation en chirurgie plastique. La technique chirurgicale repose sur des principes communs de chirurgie mammaire avec quelques precisions adaptees au thorax masculin. La liposuccion et la mastectomie sont souvent associees. Les patients sont satisfaits de retrouver une silhouette masculine normale, leur permettant de se substituer a une ambivalence qui peut peser dans leur activite socio-professionnelle.

Introduction : Called gynecomastia, the hyperplasia unilateral or bilateral, non-tumor mammary gland in men, is observed in adolescent or adult with an important psychological impact. Common condition that always requires an etiological prior to surgery. Mastectomy by periareolar incision and liposuction are often associated in this surgery. We must respect the position specific chest male in the position of the areola. Patients and methods : 15 patients operated in service in the period from January 2006 to December 2011, there were three cases with unilateral and twelve cases with bilateral, the average age was 32 years (22-47 years). Results : An unsightly appearance was observed in all patients. Breast pain was observed in three patients with fear of cancer in one patient. On examination the lymph nodes was free and there were no nipple discharge. Gynecomastia stage II bilateral is the most frequent. Echo mammography was performed in all patients and was normal. Hormonal balance was: Testosterone, Estradiol, LH, FSH, liver function tests. Testicular and abdominal ultra-sonography were good. When idiopathic gynecomastia was observed, the etiological was negative in all patients. Discussion : Gynecomastia is common in 30 % of adults. Which causes the most common were the para-pubertal gynaecomastia, the gynecomastia acquired in adulthood, also referred to other causes such as hypogonadias, hepatic and renal failure, hyperthyroidism and the sexual ambiguity. Conclusion : The gynecomastia is a common reason for consultation in plastic surgery. The surgical technique is based on common principles of breast surgery adapted with some details on the thorax male. Liposuction and mastectomy are often associated. Patients were satisfied to find a male figure, leaving an clear ambivalence that can weigh in their socio-professional activity.

The necrotizing fasciitis (NF) means a serious infection of the subcutis, the fascia and superficial dermis secondarily. We report the case of a patient with cellulitis NF of the thoracoabdominal wall complicating Dujarier's bandage. It was monobacterial NF caused by β hemolytic streptococcus, whose development was supported through an appropriate medical and surgical care. The situation mentioned is the occurrence of secondary infection of skin necrosis occurred in the bandage too tight opposite the support zone of the elbow on the trunk. We point out, through this case, the importance of the medicosurgical and also the importance of making any thoracoabdominal bandage, which could lead, if it is tight, a pressure sore can be a door entry for any NF plus a late diagnosis.

Thefts of copper appear to have been on the increase for some time owing to its high resale price. This has led to an increase in the number of high-voltage electrical accidents (HVEA). Such accidents are very serious because they cause deep burns along the neurovascular axis. A report is presented describing a series of nine patients presenting HVEA admitted to the Ibn Sina Hospital Plastic Surgery and Burns Division in Rabat, Morocco, with a study of the epidemiological, clinical, and therapeutic aspects. The patients all belonged to the young and active sector of the population. The burns were secondary to contact with high-voltage cables occurring during the attempted stealing of copper by stripping electric conductors in transformers (67% of the cases) and in attempts to cut overhead lines supplying electric trains on the railway network (33%). Electrothermal treatment of the lesions required repeated surgery with amputation and disarticulation of necrotic limb segments (67% of the cases), the consequences of which were marked by disabling functional sequelae. Preventing this type of HVEA remains fundamental.

In the present work, the influence of the inlet charge temperature is studied on the second law balance under the various operating engine speeds in DI Diesel engine. To this aim, the first law analysis is done by using the results of a three dimensional CFD model. The results show a good agreement with the experimental data. Also for the second law analysis, a developed in house computational code is applied. Behaviors of the results have a good accordance with the literature. The results show that an increase in the inlet charge temperature causes the indicated work availability, combustion irreversibility and entropy generation per cycle be reduced and the heat loss availability and exhaust gas availability be increased. Also the results reveal that the decrease in the combustion irreversibility and indicated work availability are more than the increase in the heat loss availability and exhaust gas availability when the inlet charge temperature is raised.

In this investigation, the influences of fuel injection system characteristics on the first and second laws of thermodynamics are analysed in DI diesel engines with swirl combustion chamber. The first law analysis is done by using the results of KIVA Pi code. The results show a good agreement with the experimental data. Also for the second law analysis during a closed cycle, a home made computational code is developed. Behaviours of the results are a good accordance with the literature. The results represent sensitiveness of various injection system parameters on the first and second law terms.

Le but de ce travail est d’évaluer l’intérêt du scanner multidétecteur dans la détection et l’étude des ponts myocardiques. Etude rétrospective colligeant 244 scanners cardiaques. Les ponts myocardiques ont été recherchés et étudiés sur les images axiales et au moyen de reconstructions multiplanaires, en précisant le siège exact des ponts, leur longueur, profondeur ainsi que le diamètre en diastole et en systole des segments tunnélisés. Sur les 244 patients explorés, 44 étaient porteurs de ponts myocardiques soit une prévalence de 18%. Ces ponts ont été retrouvés dans 39 cas au niveau de l’artère interventriculaire antérieure dans sa portion moyenne, dans 4 cas sur son segment distal et dans un cas sur une artère marginale. La profondeur des ponts était de 2,7 mm pour une longueur de 17 mm, en moyenne. Du fait des artefacts cinétiques liés à la contraction cardiaque, le diamètre en systole ne pouvait pas être mesuré de façon fiable. Dans tous les cas, le processus athé-romateux coronaire épargnait les segments tunnélisés alors qu’il touchait dans 15 cas le segment d’amont. Le scanner multibarrettes permet de diagnostiquer les ponts myocardiques en mettant en évidence la portion coronaire tun-nélisée et ses caractéristiques morphologiques (localisation, profondeur et longueur). La mise en évidence de la réduction ruminale en systole est plus délicate en raison des artefacts de mouvements habituels liés à la contraction ventriculaire gauche.

Préciser la sémiologie et l’apport diagnostique de la TDM pour la localisation au niveau des parties molles du kyste hydatique. Etude rétrospective de 6 patients explorés par un scanner abdomino-pelvien sans et avec injection de produit de contraste pour une localisation hydatique (foie, surrénales, rachis) ou pour une tuméfaction des parties molles. Il s’agissait de 2 femmes et de 5 hommes âgés entre 9 et 75 ans. Deux patients étaient connu porteurs d’un kyste hydatique l’un hépatique, le second surrénalien, 4 patients n’avaient pas aucun antécédent d’hydatidose connu. Une TDM abdomino-pelvienne sans et après injection de produit de contraste a été pratiquée chez tous les patients. Les localisations retrouvées étaient au sein du psoas = 6 et un kyste hydatique au niveau de la racine de la cuisse gauche, les kystes se présentaient sous la forme d’une collection à paroi non rehaussée par le produit de contraste, contenant de multiples logettes dans 6 cas et à contenu serpigineux rubané dans un cas. La localisation du KH aux parties molles est rare même dans en pays d’endémicité. Sa sémiologie en imagerie en coupes doit être connue pour ne pas faire errer le diagnostic et permettre un traitement chirurgical rapide, seul traitement curatif actuellement.

Les accidents electriques par haute tension (AEHT) provoquent des brulures profondes par effet Joule le long des axes vasculo-nerveux entre les points d'entree et de sortie, qui sont le siege de lesions delabrantes. Les Auteurs rapportent une serie de dix cas d'AEHT admis au service de chirurgie reparatrice et de brules de l'Hopital Ibn Sina de Rabat a travers laquelle ils etudient les caracteristiques epidemiologiques, cliniques et therapeutiques. Tous les patients etaient des adultes de sexe masculin dont l'âge moyen etait de 31 ans. Dans 70% des cas, ces brulures etaient secondaires a un contact avec les distributeurs d'electricite avec une surface brulee inferieure a 20%. Le traitement des lesions electrothermiques a necessite des interventions iteratives avec amputation des segments de membres necroses dans 70% des cas, dont les suites etaient marquees par des sequelles fonctionnelles invalidantes. La prevention des AEHT, en particulier pour les accidents du travail au sein des professions exposees, reste fondamentale.

210Pb was analysed in samples collected from (16) sediment traps, deployed during 1 year on the Northwestern Mediterranean continental margins, within the framework of the (MTP I)-EUROMARGE-NB programme. The traps were moored within (5) submarine canyons and their adjacent open slope, corresponding to contrasting conditions of particle inputs (fluxes and constituents). The major meso-scale observation (at the margin) is the variation in 210Pb fluxes along the slope, increasing by a factor of 2–3 between the entrance and the exit of the slope, in relation to the general (water) circulation. At a smaller scale (canyon), the 210Pb fluxes showed trends which were common to the various sites, i.e. a seaward decrease at 500m depth and an increase, with depth, in the canyons. All these features are related to mass flux variations, except for periods with huge mass fluxes, when 210Pb fluxes reached a constant value. 210Pb activities decreased with increasing mass flux; then did not show clear relationship with the concentration of the major constituents of the flux.210Pb fluxes, obtained from the traps were mainly in excess of the theoretical 210Pb flux, available in the overlying water column. Since 210Pb inventories, measured on the basis of the shelf and slope bottom sediments, were also in excess in relation to the available flux. The margin, as a whole, appears as a sink for 210Pb. This boundary-scavenging process appears to be controlled completely by the mass flux of particles. Differences were observed between 210Pb fluxes in the near-bottom traps and in the underlying sediments; there can be linked to mass flux and/or morphobathymetry (the trap flux is higher than the sediment flux in the canyon, but lower on the open slope). Overall, the differences were not in excess of 50%, confirming good representation of data collected by the sediment traps. However, this finding must be taken into account when comparing organic carbon or other constituent fluxes, between the traps and the sediment.

A detailed sedimentological and geochemical investigation was performed on slope sediments collected from the Gulf of Lions and Catalonian margins and from the northern Balearic margin. The study was based on cores, about 50 cm long. Various physiographic sites (canyons, open slopes) were selected according to the available sediment accumulation rates obtained with the Pb-210 geochronological method. At a short time scale, various parts of the slope were characterized by muddy hemipelagic sediment. Sedimentological data suggested that deposition was continuous. Total organic carbon and its hydrolysable fraction decreased downcore. Significant increase of C/N ratio downcore resulted from an early diagenetic process in response to the burial effect. However in other parts, the values of the C/N ratio were found to be irregular and maxima could frequently be related to both higher sand content and relict coastal remains derived from erosion and reworking of outcropping deposits of the last glacial maximum (lowstand system tract). Such tracts crop out over much of the shelf slope break seafloor. They provide various biological and lithological indicators: relatively well-preserved Miliolidea, coastal or lagoonal foraminifera (Ammonia beccarii, Elphidilan crispum), Characea oogons, oxidized beach-rock debris, gypsum, previously mature glauconite (with cracks) and coarse vegetal debris. Throughout the sections, the degree of diagenetic overprinting of the organic matter frequently showed a positive correlation with the abundance of some coastal indicators supporting the hypothesis of sedimentation induced predominantly by gravity These downslope accumulation may correspond to 10-40 % of the total deposit. The gravity induced transfers have been shown to be negligible in the sediment record of the northern Balearic margin. It is suggested that a reduced sedimentation rate (half that observed in the Gulf of Lions) would be expressed by a higher stability of the slope. The consequence of low sedimentation would be early diagenetic solution/reprecipitation of carbonate near the redox transition layer. (C) 2001 Ifromer/CNRS/IRD/Editions scientifiques et medicales Elsevier SAS.

An analysis of sedimentological, sediment trap and hydrological data was performed to investigate the transport and fate of particulate matter in the Gulf of Lions. The sedimentological properties outline the major sedimentary units of the shelf (Rhone prodelta, mid-shelf mud belt, outer shelf) and slope. The geometry of these sedimentary units and the southwestwards increase of particulate fluxes on the slope highlight the influence of the general cyclonic circulation on the dispersion of land-derived particulate matter. Considering the known input and output terms, budgets of particulate matter and organic carbon in the Gulf of Lions are proposed. Inputs were river supply, atmospheric deposition and primary production; outputs were sediment burial and advective export on the slope. Degradation of particulate organic carbon in the water column and at the sediment-water interface was also estimated. Mass and POC budgets were balanced within uncertainties. Nevertheless, these results illustrate the difficulty in establishing budgets based on elements estimated at different time scales, for which the system is not necessarily in a steady state. (C) 2000 Ifremer/CNRS/IRD/Editions scientifiques et medicales Elsevier SAS.

During the CINCS project (Pelagic–benthic Coupling IN the oligotrophic Cretan Sea—NE Mediterranean), a single mooring with two sediment traps (at 200 and 1515m water depth) and two current meters was deployed in the southern Cretan Sea margin at a depth of 1550 m. A second mooring deployed at the 500 m station was lost, as a result of fishing activities. The duration of the study was 12 months (November 1994 to November 1995) with sampling intervals of 15 or 16 days. The traps were retrieved, serviced and the sedimented material was collected every 6 months. In total, 48 samples were collected (24 from each trap) throughout the study period and fluxes of total particulate mass, opal, organic matter, carbonates, and lithogenic component were measured. Natural radionuclides (210Po and 210Pb) were determined for all trap samples. Total mass flux and the fluxes of four major constituents increased with depth, the total mass flux reaching values of nearly 550 mg m−2 d−1 at 1515 m and 187 mg m−2 d−1 at 200 m depth, following the same patterns observed in other experiments (ECOMARGE, SEEP-I, SEEP-II). The mean annual mass fluxes were 209 and 49.8 mg m−2 d−1 at the near bottom and near surface trap respectively. This suggests that lateral transport of particulate matter is of importance in the area. Total mass fluxes at the two depths were characterized by different seasonal fluctuations, although a general decreasing trend was observed from the I (winter) to the II (summer) deployment at both depths. This was mainly a result of reductions in aluminosilicate inputs during the summer dry period. At 200 m depth carbonates were more important during winter, because of a large carbonate input consisting mainly of coccoliths of Emiliania huxleyi, while during the summer decreased fluxes of carbonates and aluminosilicates resulted in a reduction of the mass flux. In contrast, at 1515 m depth the lithogenic component was the dominant component during the winter deployment, indicating a terrigenous input. During the summer period the decrease in mass flux was strongly effected by the decrease in aluminosilicates. There was a diminution in the organic carbon content with a concomitant increase in total mass flux, which, together with the almost negligible increase in the annual 210Pb activity with depth and the increase of 210Po activity with depth could be interpreted as indicating a contribution of resuspended material to the input at 1515 m. The complex mesoscale circulation of the Cretan Sea, consisting of a cyclone (east)–anticyclone (west) system, controls particle transfer in the area. This hydrodynamic system seems to move water masses towards the southern Cretan Sea margin, and consequently carry materials from the open sea to the upper slope and shelf.