Extensive keloids represent a major therapeutic challenge due to their high propensity for recurrence and their functional, aesthetic, and psychological impact. Surgical excision alone is associated with a high recurrence rate ranging from 40% to 100%. The use of a dermal regeneration matrix after excision, in combination with intralesional corticosteroid injections, has emerged as a promising alternative. This combined approach may improve healing quality and reduce recurrence, particularly in large or complex lesions. The objective of this study was to evaluate the effectiveness of this multimodal treatment protocol. We conducted a retrospective study of extensive keloids treated between 2015 and 2023. All lesions were completely excised and covered with a dermal matrix, followed by secondary intention healing or split-thickness skin grafting. Monthly triamcinolone injections were administered postoperatively. The primary outcome measure was the absence or significant reduction of recurrence at the end of the follow-up period. In a cohort of 66 keloids with a median follow-up of 4.15 years, this combined therapeutic approach achieved a 65% success rate. Keloids covered with both dermal matrix and skin grafting had a significantly reduced risk of recurrence ( P < 0.01). However, donor site keloid formation occurred in 20% of cases. This combined approach offers an effective solution for extensive keloids. Skin grafting appears to reduce the risk of recurrence but carries a nonnegligible risk of keloid formation at the donor site. Randomized prospective studies are needed to further validate these findings and optimize patient selection.

Tuberous breast is a congenital breast deformity that can have a significant impact. Most therapeutic algorithms involve glandular remodeling, with or without the addition of a breast implant. The increased use of fat grafting in breast surgery has introduced a new tool in the surgical arsenal. We conducted a retrospective study. The primary objective was to evaluate our surgical technique. The secondary objective was to assess patient satisfaction in a larger cohort than previously studied. This retrospective study included patients operated for unilateral or bilateral breast deformities. The fat grafting technique was offered to patients without any personal or familial history of breast cancer and with a mammogram performed within six months rated ACR 1 or 2. Patient satisfaction was retrospectively assessed at a minimum of 6 months post-op using the Breast-Q® augmentation module and an analog scale rated from 1 to 4. Statistical analysis was conducted on the 81 patients (103 breasts) included in the study. The median was two interventions. The only complication found was cystic fat necrosis cysts in 3 www.springer.com/00266 .

Background: Early excision and autologous split-thickness skin grafting are the cornerstone of surgical management in severe burn injuries. In patients with extremely extensive deep burns, the lack of available donor sites represents a major life-threatening limitation. In the exceptional situation of monozygotic twins, skin isografting offers a unique solution by providing immunologically compatible skin without the risk of rejection. Case report: We report the case of a 33-year-old man who sustained flame burns involving 95% of his total body surface area, resulting in an extremely poor initial prognosis (ABSI 14, UBS 245). After early resuscitation and staged surgical excisions, the absence of sufficient autologous donor sites precluded definitive coverage using conventional techniques. On day 3, the existence of a monozygotic twin brother was identified. HLA genotyping confirmed complete identity, and skin donation was authorized by an independent ethics committee. Methods: Definitive wound coverage was achieved using staged split-thickness skin isografts harvested from the donor twin. Ultra-thin grafts (<0.2 mm) were obtained in three procedures (days 7, 11, and 45), primarily from the scalp, thighs, and back, and applied following sequential excisions. Results: All grafts survived without immunological rejection. Donor-site morbidity was minimal, with rapid healing and only mild residual hypopigmentation. The patient was discharged to rehabilitation on day 145. At 5-year follow-up, wounds were fully healed, functional outcome was satisfactory, and quality of life was good, with return to work and full independence. Conclusions: Skin isografting from a monozygotic twin is a rare but effective salvage strategy for patients with massive deep burns when autologous donor sites are insufficient, provided that ethical, legal, and donor safety considerations are rigorously addressed.

Traumatic tattoos, resulting from the accidental impregnation of foreign particles, are common consequences of road traffic accidents and explosions. Unlike conventional tattoos, these occur when high-impact events embed foreign materials into the skin, causing persistent discoloration and cosmetic disfigurement. Preventing the permanent inclusion of these particles through immediate removal is widely considered as the best strategy. Nowadays, the preventing procedures by means of scrubbing remain insufficient and the need for delayed additional methods is one of the main causes of concern. Consequently, we aim to propose a new therapeutic protocol with enzymatic debridement to prevent and treat traumatic tattoos. In this prospective study, we included patients diagnosed with traumatic tattoos referred to our National Burn Center during 9 months (from June 2024 to March 2025). All were treated with enzymatic debridement (Nexobrid) to remove necrotic tissues after initial cleaning of the wound. Pigmented surface was evaluated before and after enzymatic debridement. A total of 15 consecutive patients were successfully treated with enzymatic debridement (Nexobrid) under sedation within the first 24 hours after the initial incident. In total, 92.5% of the surface of pigmented dermis was cleared from pigments after treatment, thus preventing the occurrence of traumatic tattoos. No adverse events were reported during the treatment. Enzymatic debridement presents a comprehensive approach to wound care in cases of traumatic tattoos, offering precision, tissue preservation, and user-friendly application, and to optimize functional and cosmetic outcomes. These advantages position it as an effective alternative to more traditional methods, particularly in settings that require minimal invasiveness and maximal tissue conservation.

Introduction: Extensive keloids represent a major therapeutic challenge due to their high propensity for recurrence and their functional, aesthetic, and psychological impact. Surgical excision alone is associated with a high recurrence rate ranging from 40% to 100%. The use of a dermal regeneration matrix after excision, in combination with intralesional corticosteroid injections, has emerged as a promising alternative. This combined approach may improve healing quality and reduce recurrence, particularly in large or complex lesions. The objective of this study was to evaluate the effectiveness of this multimodal treatment protocol. Methods: We conducted a retrospective study of extensive keloids treated between 2015 and 2023. All lesions were completely excised and covered with a dermal matrix, followed by secondary intention healing or split-thickness skin grafting. Monthly triamcinolone injections were administered postoperatively. The primary outcome measure was the absence or significant reduction of recurrence at the end of the follow-up period. Results: In a cohort of 66 keloids with a median follow-up of 4.15 years, this combined therapeutic approach achieved a 65% success rate. Keloids covered with both dermal matrix and skin grafting had a significantly reduced risk of recurrence (P < 0.01). However, donor site keloid formation occurred in 20% of cases. Conclusion: This combined approach offers an effective solution for extensive keloids. Skin grafting appears to reduce the risk of recurrence but carries a nonnegligible risk of keloid formation at the donor site. Randomized prospective studies are needed to further validate these findings and optimize patient selection.

Keloids are benign tumors resulting from pathological scarring and excessive collagen deposition with diverse clinical presentations. The treatment of keloids remains challenging, often leading to recurrences. In this study, we propose an enhanced morphological classification, derived from both previous research and a retrospective analysis of 95 keloids treated surgically in our department with a global recurrence rate of 41.1% over an average follow-up of 3.75 years. We have analyzed the clinical presentation, together with prognosis and recommendations of treatment for the several keloid phenotypes we identified. This analysis enables us to propose a keloid classification defining 5 categories: type I - Acne keloïdalis nuchae (AKN); type II - Nodular outside the ear; type III - Nodular of the ear; type IV - Superficial spreading; type V - Mixed shape. This new clinical classification of keloids was statistically predictive for the risk of recurrence after surgery (p = 0.0158). Of interest, this proposed classification not only captured all keloid presentations but also provided valuable insights for prognosis and treatment. Type I showed a favorable prognosis, with less than 20% recurrence after extralesional excision and wound healing. Types II, III, and IV had moderate recurrence rates (30-50%). Nodular keloids were treated with intralesional excision and suture, followed by corticosteroid injections. Type V, however, had a poor prognosis with a 75% recurrence rate post-surgery. This phenotype-based classification offers a better understanding of keloid pathophysiology and optimization of treatment strategies tailored to specific keloid types.

Background Chest masculinization surgery is a cornerstone of gender-affirming care for transmasculine individuals, with well-documented benefits on body image and quality of life. However, prospective data using validated patient-reported outcome measures (PROMs) remain limited. Methods This prospective longitudinal study was conducted in accordance with the STROBE guidelines. Adult transmasculine patients undergoing chest masculinization surgery at Hôpital Saint-Louis (Paris, France) between April 2022 and October 2024 were invited to complete the BODY-Q questionnaire preoperatively and at 6 months postoperatively. Demographic, morphological, and surgical variables were collected. Pre–post comparisons were performed, and associations between outcomes and covariates were explored. Results Forty-four transmasculine patients met the inclusion criteria. Mean age at surgery was 24.1 ± 5.6 years. Significant improvements were observed across all BODY-Q appearance and health-related quality-of-life domains (all P < 0.0001). For example, chest satisfaction increased from 24.0% ± 16.0% to 82.0% ± 18%, and psychological well-being from 24.0% ± 22.0% to 62.0% ± 19%. No statistically significant associations were identified between postoperative BODY-Q scores and surgical technique, BMI, or demographic variables; however, these findings should be interpreted with caution given the limited sample size. Postoperative expectations remained stable, suggesting realistic preoperative counseling. Conclusions Chest masculinization surgery was associated with marked improvements in appearance-related satisfaction and health-related quality of life at 6 months. Despite limitations related to sample size, response rate, and follow-up duration, these findings support the substantial positive impact of this procedure on patient-reported outcomes in transmasculine individuals.

Background:Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are difficult to manage because of their subclinical extension and ill-defined margins, especially on chronically sun-damaged facial skin. Reflectance confocal microscopy (RCM), a non-invasive imaging technique with near-histological resolution, has emerged as a valuable adjunct for diagnosis, presurgical margin mapping, and postoperative surveillance. Objective:To systematically review current evidence on the role of RCM in LM and LMM management. Methods:A systematic review was performed in accordance with PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched up to July 2025. Eligible studies assessed RCM for diagnostic accuracy, presurgical mapping, surgical outcomes, or follow-up. Findings were synthesized qualitatively. Results:Twenty-nine studies were included. Across diverse study designs, RCM demonstrated higher diagnostic accuracy than dermoscopy for LM, with reported sensitivities ranging from 85 % to 100 % and specificities from 71 % to 97 %. In comparative studies and meta-analyses, RCM showed superior specificity compared with dermoscopy and improved discrimination between LM and early invasive LMM. Presurgical RCM margin mapping was associated with higher first-stage clearance rates (up to 63.6 % vs. 34.7 % with standard assessment), fewer surgical stages (mean 1.1-1.2 vs. 1.7-1.9), narrower excision margins, and lower local recurrence rates (approximately 2-5 % vs. up to 13 % in non-RCM series). RCM was also effective for monitoring non-surgical therapies and detecting early recurrences within surgical scars. Major barriers to widespread adoption include cost, limited availability, training requirements, and the absence of standardized protocols. Conclusions:RCM strengthens the management of LM and LMM by improving diagnostic confidence, enabling precise margin mapping, and supporting long-term surveillance. Broader adoption will depend on standardization of mapping techniques, integration into clinical workflows, and validation of artificial intelligence-assisted interpretation.

BACKGROUND:Between 2009 and 2022, a homogenous cohort of patients at Saint-Louis hospital affected by keloid scars undergone excision surgery followed by HDR brachytherapy on the same day. PURPOSE:To assess the percentage of long-term recurrence and look for the presence of influencing factors. MATERIALS AND METHODS:Inclusion criteria included the presence of one or more keloid scars and histological confirmation of the diagnosis. Exclusion criteria comprised a history of keloid surgery other than simple excision, and the absence of intraoperative direct suturing of the scar. RESULTS:A total of 87 keloids scare were eligible for the analysis. Median follow-up was 89,7 months (IQR: 60.2-120.2). 34 recurrences (39%) were observed. Of these recurrences, 41% (14 of 34) showed a significant reduction in keloid volume, 29% (10 of 34) returned to the original keloid volume, and 29% (10 of 34) demonstrated an increase in volume. The recurrence-free survival for all cheloid was 0.89 [0.45;0.98] at one year and 0.67 [0.28;0.89] at 5 years. Keloid of the ear compared to other sites (HR = 0.38, 95% CI: 0.17-0.85, p = 0.02) was significantly associated with a lower recurrence risk. Male sex (HR = 2.13, 95% CI: 0.88-5.14, p = 0.09) and prior treatment (HR = 3.44, 95% CI: 0.85-13.89, p = 0.08) were associated with an increased recurrence risk. CONCLUSION:With a prolonged follow-up and a rigorous methodology compared to previous studies, our results lead us to preferentially recommend postoperative brachytherapy for keloid located in the ears, especially for women without any previous treatment.

Macrophages participate in cutaneous wound healing by adopting M1 pro-inflammatory and M2 immunoregulatory/pro-repair phenotypes. Chronic wounds associated with a deficient macrophage response could benefit from treatments that restore an acute inflammatory response and promote healing. Calcium-alginate dressings release calcium ions, which are potent bioactivators of macrophage function in wounds. Here, the effects of two calcium-alginate dressings, Algosteril® (ALG, pure Ca2+ alginate) and Biatain® Alginate (BIA, Ca2+ alginate with carboxymethyl cellulose), and a 3 mM CaCl2 solution were compared in human macrophages polarized to M1 or M2. ALG and CaCl2 preserved monocyte viability, and BIA reduced it. Both alginates and CaCl2 reinforced the M1 pro-inflammatory transcriptional profile and phenotype, with significant increases in IL-6 and TNF-α secretion by ALG only. In M2 macrophages, all conditions increased the M1-specific gene expression and reduced M2 markers, suggesting an orientation toward an inflammatory profile. Only ALG significantly increased the secretion of CCL18 and VEGF, suggesting pro-repair activity. All conditions increased M2 phagocytic activity. This work demonstrates the interest in calcium alginates for stimulating macrophage subtypes, which could help restore wound healing, especially in patients with compromised innate immunity. It highlights the differences among the calcium-alginate dressings. The pure alginate shows higher stimulation of macrophage pro-inflammatory and pro-repair functions.

BACKGROUND:Lentigo maligna (LM) and its invasive form, lentigo maligna melanoma (LMM), often occur in sun-exposed areas and are characterized by subclinical extension, thereby complicating margin delineation. Reflectance confocal microscopy (RCM) has emerged as a non-invasive imaging tool for presurgical mapping of such lesions. OBJECTIVE:To evaluate the impact of RCM on surgical outcomes in LM/LMM compared to standard clinical and dermoscopic assessment. METHODS:We conducted a retrospective comparative cohort monocentric study by including 282 patients treated for LM or LMM between 2018 and 2025. Patients were divided into 2 groups: 184 who underwent presurgical RCM mapping (RCM group), and 98 who received standard care without RCM (non-RCM group). Surgical outcomes-including number of procedures, surgical margin, and recurrence rates-were compared between the groups. RESULTS:The rate of complete excision after a single procedure was significantly higher in the RCM group (63.6%) compared to the non-RCM group (34.7%, p < 0.0001). Patients in the RCM group required fewer surgical stages (mean 1.18 vs. 1.94; p < 0.0001) and narrower margins (mean 5.2 mm vs. 6.2 mm; p = 0.002). These benefits were especially notable in complex facial subregions. Median follow-up durations were comparable between the groups (1096.5 vs. 1167.5 days; p = 0.27). CONCLUSION:RCM-guided surgery improved margin control and surgical efficiency in LM and LMM, especially in anatomically complex regions. These results support the integration of RCM into routine preoperative planning for LM/LMM.

BACKGROUND:Post-radiation fibrosis and vascular compromise significantly complicate elective breast surgeries in previously irradiated patients, despite a high incidence of post-treatment asymmetry and macromastia. This study evaluates complication profiles across surgical techniques to provide evidence-based guidance for breast reduction and mastopexy in irradiated breasts. METHODS:A retrospective cohort of 41 patients with prior breast irradiation undergoing bilateral breast reduction (n=30), mastopexy (n=7), or mixed procedures (n=4) between 2015-2023 was analyzed. Reduction techniques included superior pedicle (n=4), supero-medial pedicle (n=12), and Thorek free nipple graft (n=14); mastopexies employed Wise-pattern superior pedicle techniques. Outcomes were compared with 1442 non-irradiated breast reductions. Complications were classified as major (reoperation required) or minor (conservatively managed). Statistical analysis utilized Fisher's exact tests and odds ratios (SPSS v26). RESULTS:Irradiated breasts had significantly higher overall complication rates compared to non-irradiated controls (44% vs. 21%; OR 3.017; p=0.0014), with seromas occurring exclusively in irradiated cases (15% vs. 0%; p<0.001). Mastopexies showed higher dehiscence rates than reductions (29% vs. 0%; p=0.01). Among reduction techniques, the supero-medial pedicle had the highest complication rate (67%), while Thorek procedures showed no seromas (p=0.04). No major complications occurred; revisions (15%) addressed asymmetry only. CONCLUSIONS:Breast surgery in irradiated fields remains viable when guided by technique-specific risk profiles and conservative tissue handling. Mastopexy carries elevated dehiscence risks, while the Thorek technique may reduce seroma formation in high-risk patients. Because subgroup analyses were under-powered, all technique-related recommendations should be regarded as preliminary and hypothesis-generating, pending validation in larger multicentre cohorts.

Breast reduction surgery is a widely performed plastic surgery procedure. The incidence of such complications has been steadily decreasing in recent years but is still nonetheless 5.6 www.springer.com/00266 .

Introduction Le lambeau antérolatéral de cuisse est, dans certains cas prélevé, avec une partie de l’aponévrose du muscle quadriceps ce qui peut entraîner des hernies musculaires, ou des adhérences au niveau du site donneur. Les études rapportent entre 11 et 32 % de survenue de hernies musculaires et entre 8 et 26 % de faiblesse persistante de la zone donneuse. Il n’y a pas de données dans la littérature scientifique présentant de technique chirurgicale de prévention des hernies musculaires au niveau du site donneur du lambeau antérolatéral de cuisse. L’objectif de notre étude est de décrire notre technique de mise en place d’une plaque synthétique en cas d’impossibilité de fermeture de l’aponévrose lors de la levée d’un lambeau antérolatéral de cuisse afin de limiter le risque de survenue de hernies musculaires postopératoires et d’en analyser les bénéfices. Matériel et méthode Dans le cadre d’une étude prospective, nous présentons ici notre technique de reconstruction de l’aponévrose par pose de plaque synthétique non résorbable. Résultats Vingt-deux patients ont bénéficié de la pose d’une plaque pour la reconstruction du défect aponévrotique qui était de 9,6cm en moyenne. Un an après l’intervention aucun ne présentait de hernie musculaire ni adhérence au niveau du site donneur. Discussion Présents dans 11 à 32 % selon les études, les hernies musculaires et adhérences cicatricielles sont disgracieuses et invalidantes pour les patients. S’il paraît difficile de quantifier le bénéfice en termes de force musculaire la reconstruction de l’aponévrose prévient efficacement de ce type de complications. Lorsque le défect est supérieur à 8cm, il nous semble indispensable de reconstruire l’aponévrose lors de la levée afin de prévenir la survenue de hernie ou d’adhérence du site donneur. Bien que ne retentissant pas sur la fonction du membre, la hernie musculaire est au moins gênante esthétiquement et mériterait d’être prévenue de façon systématique. Conclusion La reconstruction de l’aponévrose musculaire de la zone donneuse du lambeau antérolatéral de cuisse par une plaque synthétique non résorbable en cas de défect supérieur à 8cm permet de prévenir la survenue d’hernies musculaires et d’adhérences sources de complications esthétiques et fonctionnelles.

Introduction: The objective of this work was to determine the prevalence of Body Dysmorphic Disorder (BDD) symptoms in plastic and aesthetic surgery consultations in a large cohort of patients presenting for initial consultations for various indications. Results: We conducted a prospective, single-center cohort study between January 2022 and November 2022. A total of 1169 questionnaires were collected, and 842 patients were included in the study. Among the entire population, 180 patients screened positive test and were thus considered at high risk for BDD. This represented 21.4% of our population. Regarding the impact on their sexual and/or romantic life, 40% of our patients indicated that their BDD symptoms affected their sexual life, which aligns with the findings of Brito, who found that patients with BDD+ had significantly higher sexual inhibition than those with BDD-, with sexual inhibition reported in 51% of patients with BDD+ compared with 28% of patients with BDD-. Discussion: The prevalence of BDD symptoms in our population (21.4%) is close to the average found in other prevalence studies on BDD in plastic surgery. Our cohort, which is the largest prospective cohort conducted on the subject to date, is very representative of the population presenting to plastic surgery for consultation. It also presents the most extensive range of surgical indications ever studied in the literature. Conclusion: BDD most often affects patients under 50 years old who consult for rhinoplasty or otoplasty. Only severe presentations of BDD are risk factors for postoperative dissatisfaction. Therefore, it is essential to diagnose such cases and direct these patients toward psychiatric care rather than operating on them.

Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .