Introduction. - The success of surgeries involving free flaps largely depends on accurate preoperative mapping of perforator arteries. Various imaging techniques, such as Doppler ultrasound and CT angiography, are typically used, each having its advantages and disadvantages in terms of cost, accuracy, and patient risk. The main objective of our study is to compare the effectiveness of the FLIR One device for detecting these arteries compared with traditional methods. Thermal imaging appears to be a simpler, less expensive, and less invasive alternative for surgical planning. Material and method. - The study, conducted at the Regional Hospital Center of Nancy, included 25 free flaps (DIEP) on an exclusively female cohort of 22 patients, with follow-up from 2022 to 2023. Before the procedure, an abdominal-pelvic CT angiography was performed, followed by additional evaluation with thermal imaging using FLIR One and acoustic Doppler examination on the eve of the operation. This approach aimed to provide precise mapping of vascular perforators for each patient. Three different operators performed these markings, and the results were then compared with intraoperative observations. The imaging protocol also included a Doppler examination to validate the results of the thermal imaging. Statistical analyses with intraclass correlation coefficients (ICC) were performed to evaluate the correlation between different preoperative localization methods of perforating vessels. Results. - In 22 patients undergoing 25 DIEP flaps for breast reconstructions, three imaging techniques were used to identify vascular perforators: thermal imaging with FLIR, acoustic Doppler, and CT angiography. FLIR identified the most perforators (n = 137), followed by acoustic Doppler (n = 128) and CT angiography (n = 126). Comparing these with intraoperative results, 66% of perforators identified by FLIR were confirmed, 70% for acoustic Doppler, and 95% for CT angiography. The ICCs shows a significant correlation between these imaging techniques and intraoperative results. FLIR demonstrated a strong correlation with intraoperative observations (ICC of 0.74, P < 0.001), followed by a moderate correlation with acoustic Doppler (ICC of 0.56, P < 0.03) and CT angiography (ICC of 0.52, P < 0.006). Conclusion. - The study concludes that thermal imaging with FLIR is a reliable and effective tool for locating vascular perforators. Although the study and FLIR have their own limitations, the tool presents several advantages such as ease of use, speed, and affordability. These characteristics make FLIR particularly attractive as a complement to traditional detection methods, such as acoustic Doppler and CT angiography. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Introduction La réussite des chirurgies impliquant des lambeaux libres dépend notamment d’une cartographie préopératoire précise des artères perforantes. Différentes techniques d’imagerie, comme le Doppler et l’angiographie tomodensitométrique, sont généralement employées, chacune ayant ses avantages et inconvénients en termes de coût, de précision et de risques pour le patient. L’objectif principal de notre étude est de comparer l’efficacité du dispositif FLIR One pour la détection de ces artères, en comparaison avec les méthodes traditionnelles. L’imagerie thermique, semblant pouvoir être une alternative plus simple, moins coûteuse et moins invasive lors planification chirurgicale. Matériel et méthode L’étude, réalisée au centre hospitalier régional de Nancy, a inclus 25 lambeaux libres (DIEP) sur une cohorte exclusivement féminine de 22 patientes, avec un suivi allant de 2022 à 2023. Avant l’intervention, un angioscanner abdominopelvien était effectué, suivi d’une évaluation complémentaire avec l’imagerie thermique FLIR One et un examen Doppler acoustique la veille de l’opération. Cette démarche visait à fournir une cartographie précise des perforantes vasculaires pour chaque patient. Trois opérateurs différents ont réalisé ces marquages, et les résultats ont ensuite été comparés avec les observations peropératoires. Le protocole d’imagerie incluait également un examen Doppler pour valider les résultats de l’imagerie thermique. Des analyses statistiques avec indices de corrélation intraclasse (ICC) ont été effectuées pour évaluer la corrélation entre les différentes méthodes de localisation préopératoire des vaisseaux perforants. Résultats Vingt-deux patientes ayant bénéficié 25 lambeaux de DIEP pour des reconstructions mammaires, trois techniques d’imagerie ont été utilisées pour identifier les perforantes vasculaires : l’imagerie thermique FLIR, le Doppler acoustique et l’angioscanner. FLIR a identifié le plus grand nombre de perforantes (n=137), suivi du Doppler acoustique (n=128) et de l’angioscanner (n=126). Lors de la comparaison avec les résultats peropératoires, 66 % des perforantes identifiées par FLIR ont été confirmées, 70 % pour le Doppler acoustique, et 95 % pour l’angioscanner. L’indice de corrélation intraclasse (ICC) montre une corrélation significative entre ces techniques d’imagerie et les résultats peropératoires. Le FLIR a démontré une forte corrélation avec les observations peropératoires (ICC de 0,74, p<0,001), suivie d’une corrélation modérée avec le Doppler acoustique (ICC de 0,56, p<0,03) et l’angioscanner (ICC de 0,52, p<0,006). Conclusion L’étude conclut que l’imagerie thermique FLIR est un outil à la fois fiable et efficace pour la localisation des perforantes vasculaires. Bien que l’étude et le FLIR aient leurs propres limitations, l’outil présente plusieurs avantages comme la facilité d’utilisation, la rapidité et le coût abordable. Ces caractéristiques rendent le FLIR particulièrement attractif comme complément aux méthodes traditionnelles de détection, telles que le Doppler acoustique et la tomodensitométrie (TDM).

Introduction. - Multiple surgical revisions (exeresis and directed healing) of recurrent pilonidal cysts are sources of unstable scars. Chronic ulcerations often appear with or without authentic recidivism. A local fasciocutaneous perforating flap based on the parasacral arteries would bring healthy tissue and avoid the disadvantages of conventional techniques (musculo-cutaneous or random). Materials and methods. - A series of 8 cases of transposition flap covering based on parasacral perforators, in multi-operated patients. The perforators are identified by Doppler probe before the gesture, then the flap is traced obliquely according to the size of the loss of substance. The gesture is short, not morbid and accessible to all by a technique that excludes fine dissection of the pedicle. The duration of hospitalization is 2 days. Results. - Despite two minor and resolving complications (a hematoma and a disunion of the donor sit) the healing was complete and without recurrence in all patients at 2 years, with 100% satisfaction. Conclusion. - This reliable and reproducible simple flap becomes the reference technique in our department for the sequelae of recurrent sacro-coccygeal cyst. (C) 2021 Elsevier Masson SAS. All rights reserved.

Background. - Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results. Methods. - We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications. Results. - Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3 years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable. Conclusions. - Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful. (C) 2019 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:The objective of this study is to highlight the factors that influence drain productivity in reduction mastoplasty. MATERIALS AND METHODS:We have retrospectively referenced from November 2015 to November 2017 all breast reduction performed in the plastic surgery, reconstructive and esthetic surgery department of the University Hospital of Nancy. A total of 222 breasts were analyzed by listing age, weight, height, Body Mass Index (BMI), smoking status, surgeon, technical used, hospitalization stay, breast volume removed, type and size of drain and their productivity. Multivariate analysis were realised. RESULTS:118 patients were included with an average age of 42.2 years. The average productivity of drains was 50 millilitres (ml). There was a significant difference in productivity of drainage according to the operator with a median ranging from 10ml to 60ml (P<0.0001). The median was 20ml for 10 Redon-Jost drains versus 50ml for the 16 Redon-Jost drains (P<0.0001). Multivariate analysis of the various factors influencing the total productivity of postoperative drainage showed a relative risk of 1.16 for smokers, 0.24 for one surgeon, 1.68 for the Skoog technique, and 1.000 for breast volume removed. CONCLUSION:The drain productivity is not predictable before a breast reduction. Indeed, none of the characteristics studied have sufficient influence on the productivity of the drains.

Subject. - The objective of this study is to report our experience in the management of septic complications arising from pulmonary resection surgery by placing a pedicled upper back muscle flap associated with dressings by therapy. Negative pressure in all patients supported in our center from November 2015 to March 2018. Material and methods. - Characteristics of fourteen patients with a pedicled dorsal muscle flap in the context of chronic empyema associated with bronchopulmonary fistula were identified. Flap placement time, complications, and success rate were assessed. Results. - The median flap placement after completion of the open window thoracostomy was 19 days [3-65]. The median healing time was 3 months. Healing was definitively achieved in 12 patients, a success rate of 86%. Conclusion. - Through this series we have shown that our coverage by pneumonectomy cavity coverage with an early dorsal muscle flap associated with negative pressure therapy, has a similar mortality rate and success rate to those found in the literature. (C) 2019 Elsevier Masson SAS. All rights reserved.

Resume Introduction Le cancer du sein et sa prise en charge restent un probleme majeur de sante publique chez la femme. L’epidemiologie des complications liee a la radiotherapie apres une reconstruction mammaire immediate prothetique (RMIP) reste insuffisante et ses consequences esthetiques mal definies. L’objectif de ce travail etait de comparer les taux de complications et les resultats esthetiques des reconstructions mammaires immediates (RMI) par prothese avec et sans radiotherapie, afin de determiner les facteurs de risques de complications et de mauvais resultats esthetiques. Materiel et methode Une etude retrospective a ete conduite entre janvier 2014 et decembre 2016 portant sur des patientes atteintes d’un cancer du sein et devant beneficier d’une mastectomie totale sous cutanee (MTSC) avec une RMIP. Le critere d’evaluation etait le taux d’echec de reconstruction et le rendu esthetique global, les criteres secondaires evaluaient le taux de complications precoces et tardives. Il fut realise une analyse multivariee pour deceler des facteurs de risques predictifs de complication. Resultats Trois cent trente-trois patientes ont ete incluses : 157 dans le bras radiotherapie et 176 pour le groupe sans radiotherapie. Les caracteristiques preoperatoires etaient comparables. Le suivi moyen etait de 1 a 3 ans sans perdu de vue. Le resultat sur le critere de jugement principal montrait que les patientes qui avaient beneficie d’une radiotherapie avaient le meme risque d’echec de reconstruction que les patientes non irradiees. L’analyse en sous-groupe ne revelait aucune difference significative : 12,7 % d’echec de reconstruction pour le bras irradie versus 12,5 %. Concernant l’evaluation de l’alteration des resultats esthetiques, il fut constate comme difference un meilleur taux de patientes avec d’« excellents » resultats dans le bras sans radiotherapie (35 % vs 8,2 %). Les resultats sur les criteres secondaires etaient comparables. Conclusion La radiotherapie chez les patientes beneficiant d’une RMIP n’augmente pas le risque d’echec de reconstruction et de mauvais resultats esthetiques comparativement aux patientes non irradiees. Il est donc licite de proposer pour toutes patientes devant beneficier d’une MTSC suivie d’une radiotherapie, une RMIP et ainsi de leur eviter une reconstruction secondaire, plus impactante sur le plan psychologique.

Introduction. - Each university hospital has its own specificities in microsurgical reconstructions. Activities may focus on breast reconstruction, ENT reconstruction or traumatic substance loss. This study analyzes the specificities at the University Hospital of Nancy, studies the indications, the operating data and the failure rates. Method. - We realized a historical cohort of microsurgical reconstructions at Nancy University Hospital from January 1, 2004 to December 31, 2017. All free flaps were included and analyzed. Results. - A total of 359 free flaps were made. The failure rate was 9.47%. Forty eight different operators have been identified. Substance losses were essentially traumatic (56.8%). A total of 20 different flaps were use with 49% bone reconstruction. The fibula flap was the first flap used (26.5%). Arterial anastomoses were performed in termino-lateral in 44% and venous anastomoses were single in 70.5%. High BMI, diabetes, high blood pressure, atherosclerosis, and arterial or venous graft were identified as risk factors for failure (P < 0.05). The smoking and the realisation of the intervention by a young operator have no impact on the success rate. Conclusion. - Our specificity is the bone reconstruction which represents a significant part of our activity. In the university center, the number of etiology of substance losses, operator and flap used is important but it still allows to obtain results in adequacy with the literature. (C) 2019 Elsevier Masson SAS. All rights reserved.

Each university hospital has its own specificities in microsurgical reconstructions. Activities may focus on breast reconstruction, ENT reconstruction or traumatic substance loss. This study analyzes the specificities at the University Hospital of Nancy, studies the indications, the operating data and the failure rates.We realized a historical cohort of microsurgical reconstructions at Nancy University Hospital from January 1, 2004 to December 31, 2017. All free flaps were included and analyzed.A total of 359 free flaps were made. The failure rate was 9.47%. Forty eight different operators have been identified. Substance losses were essentially traumatic (56.8%). A total of 20 different flaps were use with 49% bone reconstruction. The fibula flap was the first flap used (26.5%). Arterial anastomoses were performed in termino-lateral in 44% and venous anastomoses were single in 70.5%. High BMI, diabetes, high blood pressure, atherosclerosis, and arterial or venous graft were identified as risk factors for failure (P<0.05). The smoking and the realisation of the intervention by a young operator have no impact on the success rate.Our specificity is the bone reconstruction which represents a significant part of our activity. In the university center, the number of etiology of substance losses, operator and flap used is important but it still allows to obtain results in adequacy with the literature.

Smoking increases perioperative risk regarding wound healing, infection rate and failure of microsurgical procedures. There is no present consensus about plastic and aesthetic surgical indications concerning smoking patients. The aim of our study is to analyze French plastic surgeons practices concerning smokers.A questionnaire was send by e-mail to French plastic surgeons in order to evaluate their own operative indications: patient information about smoking dangers, pre- and postoperative delay of smoking cessation, type of intervention carried out, smoking cessation supports, use of screening test and smoking limit associated to surgery refusing were studied. Statistical tests were used to compare results according to practitioner activity (liberal or public), own smoking habits and time of installation.In 148 questionnaires, only one surgeon did not explain smoking risk. Of the surgeons, 49.3% proposed smoking-cessation supports, more frequently with public practice (P=0.019). In total, 85.4% of surgeons did not use screening tests. Years of installation affected operative indication with smoking patients (P=0.02). Pre- and postoperative smoking cessation delay were on average respectively 4 and 3 weeks in accordance with literature.Potential improvements could be proposed to smoking patients' care: smoking cessation assistance, screening tests, absolute contraindication of some procedures or level of consumption to determine.

INTRODUCTION:Bacterial necrotizing dermis-hypodermitis and necrotizing fasciitis (BNDH-NF) are serious life-threatening soft-tissue infections. The object is to evaluate the quality of life (QOL) of patients who have been operated in our plastic surgery departement. PATIENTS AND METHODS:This is a retrospective study of cases who have been treated at Nancy University Hospital between 2005 and 2014. We analyzed the perioperative data (demographic, clinical, bacteriological), the surgical data (excision, reconstruction) and the follow up data (consequences, mortality). The quality of life was assessed by the Short-Form 36 score, and the patients' satisfaction was assessed by a four-level scale. RESULTS:We analyzed 23 patients with an average age of 60 years (28-84 years). The main comorbidities were diabetes (43 %) and obesity (39 %). The average number of surgical excision was about 1.9 (1-5) and the average excised body surface area was about 5 % (1-16 %). The short-term mortality was about 17 %. The mortality rate has been statistically correlated with the surgically excised body surface area (short-term 95 days: P=0.02; and long-term: P=0.003). The statistical analysis has shown a strong relative linear relationship between number of surgical excision and the physical score of QOL (P<0.001), between number of surgical excision and mental score of QOL (P=0.032), and between age and physical score of QOL (P≤0.021). The statistical analysis has also shown a strong relative linear relationship between E. coli infections and physical score of QOL (P=0.01). The percentage of patients' satisfaction in our study was evaluated at 86 %. CONCLUSION:We have found that multiple surgical excisions, an advanced age of patients and E. coli infections have been associated with poor QOL. The mortality rate increased in relation with the importance of excised body surface. In spite of the gravity of these infections, our patients were satisfied of their treatment.

Introduction. - Abdominoplasty procedures sometimes reveal the presence of ventral hernias (umbilical or trocar-site hernias). Our objective is then to deal with the excess abdominal skin and fat tissue at the same time as the ventral hernia. This can be done with a single surgical procedure combining abdominoplasty with umbilical transposition and laparoscopic ventral hernia repair (LVHR) with mesh. The main objective of our study is to assess the outcome of the combined procedure of abdominoplasty and LVHR with mesh, compared to abdominoplasty alone.Materials and methods. - A retrospective single-centre cohort study was conducted, including patients operated on with the combined method (ABDO-LVHR group) and patients who underwent abdominoplasty alone (ABDO group). We noted major and minor complications, with infection issues as our main concern.Results. - We included 15 patients in the ABDO-LVHR group and 30 in the ABDO group. The results show no statistically significant difference for infectious complications in the ABDO-LVHR group compared to the ABDO group (20% vs 3.3%; P = 0.100). There was no instance of complete umbilical necrosis. Other major and minor complications occurred at the rates typically described in the literature without difference between the two groups.Conclusion. - There was no significant difference between our two groups in terms of infectious complications. LVHR carried out at the same time as abdominoplasty with umbilical transposition is a positive combination of procedures. Further studies are necessary to confirm that the risk in terms of infectious complications is no higher than for abdominoplasty alone. (C) 2016 Elsevier Masson SAS. All rights reserved.

Les dermo-hypodermites bactériennes et fasciites nécrosantes (DHBN-FN) sont des infections graves des tissus mous mettant en jeu le pronostic vital. L’objectif est d’évaluer la qualité de vie des patients opérés d’une DBHN-FN. Il s’agit d’une étude monocentrique rétrospective des cas de DHBN-FN traités au CHU de Nancy entre 2005 et 2014. Nous avons analysé les données périopératoires (démographiques, cliniques, bactériologiques), les données chirurgicales (excision, reconstruction) et le suivi (séquelles, mortalité). La qualité de vie (QDV) a été évaluée par le score SF-36, et la satisfaction des patients par une échelle à 4 niveaux. Nous avons analysé 23 patients, avec un âge moyen de 60 ans (28–84 ans). Les comorbidités principales étaient diabète (43 %) et obésité (39 %). Il y a eu en moyenne 1,9 excisions (1–5), et 5 % (1–16 %) de surface corporelle totale excisée par patient. La mortalité lors du premier séjour hospitalier était de 17 %. Une plus grande surface excisée était statistiquement associée à une moindre survie lors du premier séjour hospitalier (p = 0,02) et à long terme (p = 0,003). L’analyse statistique a montré des relations linéaires fortes négatives entre : le nombre d’excisions et le score physique de QDV (p < 0,001), le nombre d’excisions et le score mental de QDV (p = 0,032), et entre l’âge et le score physique de QDV (p = 0,021). L’analyse statistique a également montré une relation linéaire forte négative entre la présence d’E. coli et le score physique de QDV (p = 0,01). Les survivants étaient très satisfaits de leur prise en charge dans 86 % des cas. Nous avons constaté que des excisions multiples, un âge avancé et la présence d’E. coli sont associés à une plus mauvaise qualité de vie. D’autre part, une surface excisée importante augmentait la mortalité. Malgré la gravité de cette infection, les patients ont été satisfaits de leur prise en charge. Bacterial necrotizing dermis-hypodermitis and necrotizing fasciitis (BNDH-NF) are serious life-threatening soft-tissue infections. The object is to evaluate the quality of life (QOL) of patients who have been operated in our plastic surgery departement. This is a retrospective study of cases who have been treated at Nancy University Hospital between 2005 and 2014. We analyzed the perioperative data (demographic, clinical, bacteriological), the surgical data (excision, reconstruction) and the follow up data (consequences, mortality). The quality of life was assessed by the Short-Form 36 score, and the patients’ satisfaction was assessed by a four-level scale. We analyzed 23 patients with an average age of 60 years (28–84 years). The main comorbidities were diabetes (43 %) and obesity (39 %). The average number of surgical excision was about 1.9 (1–5) and the average excised body surface area was about 5 % (1–16 %). The short-term mortality was about 17 %. The mortality rate has been statistically correlated with the surgically excised body surface area (short-term 95 days: P = 0.02; and long-term: P = 0.003). The statistical analysis has shown a strong relative linear relationship between number of surgical excision and the physical score of QOL (P < 0.001), between number of surgical excision and mental score of QOL (P = 0.032), and between age and physical score of QOL (P ≤ 0.021). The statistical analysis has also shown a strong relative linear relationship between E. coli infections and physical score of QOL (P = 0.01). The percentage of patients’ satisfaction in our study was evaluated at 86 %. We have found that multiple surgical excisions, an advanced age of patients and E. coli infections have been associated with poor QOL. The mortality rate increased in relation with the importance of excised body surface. In spite of the gravity of these infections, our patients were satisfied of their treatment.

Introduction. - Since the beginning of the 21st century, three-dimensional imaging systems have been used more often in plastic surgery, especially during preoperative planning for breast surgery and to simulate the postoperative appearance of the implant in the patient's body. The main objective of this study is to assess the patients' attitudes regarding 3D simulation for breast augmentation. Method. - A study was conducted, which included women who were operated on for primary breast augmentation. During the consultation, a three-dimensional simulation with Crisalix was done and different sized implants were fitted in the bra. Results. - Thirty-eight women were included. The median age was 29.4, and the median prosthesis volume was 310 mL. The median rank given regarding the final result was 9 (IQR: 8-9). Ninety percent of patients agreed (66% absolutely agreed, and 24% partially agreed) that the final product after breast augmentations was similar to the Crisalix simulation. Ninety-three percent of the patients believed that the three-dimensional simulation helped them choose their prosthesis (61% a lot and 32% a little). After envisaging a breast enlargement, patients estimated that the Crisalix system was absolutely necessary (21%), very useful (32%), useful (45%), or unnecessary (3%). Regarding prosthesis choice, an equal number of women preferred the 3D simulation (19 patients) as preferred using different sizes of implants in the bra (19 patients). Conclusion. - The present study demonstrated that 3D simulation is actually useful for patients in order to envisage a breast augmentation. But it should be used as a complement to the classic method of trying different sized breast implants in the bra. (C) 2017 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Smoking increases perioperative risk regarding wound healing, infection rate and failure of microsurgical procedures. There is no present consensus about plastic and aesthetic surgical indications concerning smoking patients. The aim of our study is to analyze French plastic surgeons practices concerning smokers. METHOD:A questionnaire was send by e-mail to French plastic surgeons in order to evaluate their own operative indications: patient information about smoking dangers, pre- and postoperative delay of smoking cessation, type of intervention carried out, smoking cessation supports, use of screening test and smoking limit associated to surgery refusing were studied. Statistical tests were used to compare results according to practitioner activity (liberal or public), own smoking habits and time of installation. RESULTS:In 148 questionnaires, only one surgeon did not explain smoking risk. Of the surgeons, 49.3% proposed smoking-cessation supports, more frequently with public practice (P=0.019). In total, 85.4% of surgeons did not use screening tests. Years of installation affected operative indication with smoking patients (P=0.02). Pre- and postoperative smoking cessation delay were on average respectively 4 and 3 weeks in accordance with literature. CONCLUSION:Potential improvements could be proposed to smoking patients' care: smoking cessation assistance, screening tests, absolute contraindication of some procedures or level of consumption to determine.

Introduction. - Photography in plastic surgery is omnipresent. Through its various uses, it may present both ethical and forensic risks. The objective of this study is to analyze the use of medical photography by the plastic surgeon, the perception of this use by the patient, and consequence of such use.Method. - A questionnaire about the use of medical photography was assessed to 629 plastic surgeons. A questionnaire was given to patients, about their perception of the use of photography by their surgeon.Results. - One hundred and seventy-six surgeon's questionnaires and 93 patient's questionnaires were analyzed. For 97.7% of the responding surgeons, the proportion of patients refusing to be photographed was less then 1/20. The objective of the photography was especially medicolegal for 62.5% of the surgeons, especially for following the patient progress (87.5%), partially for the formation (72.1%), partially for scientific publications (57.8%) and not at all for the personal publicity (73.1%). Surgeons often share his photographs with others surgeons (71.1%), sometimes with others medical personnel (48.8%). The security and the access to photographs were determined to be correct for 67.6% of the surgeons and perfect for 23.3%. In total, 17.2% of the surgeons obtained a written consent, 41.4% obtained an oral consent, and 38.5% did not request patient consent. It was found that 48.3% of the surgeons and 40.2% of the patients think that the right to the photographic images belong to the patient.Conclusion. - Medical photographs expose the plastic surgeon to medico-legal risks. He must know and follow the law in order to prevent eventual legal proceedings. (C) 2014 Elsevier Masson SAS. All rights reserved.

Women who have undergone surgical treatment for breast cancer often benefit from a contralateral reduction mammaplasty (CRM) aimed at symmetrization of the contralateral breast unaffected by the initial cancer. In our 7-year multicentric study (12 centers) of 2718 patients, incidence of CRM cancers (CRMc) was 1.47% (n = 40) [95% CI 1.05%-2.00%]. The CRMc group had significantly more initial mammary cancers of invasive lobular carcinoma (ILC, 22.5% vs 12.0%) and ductal carcinoma in situ (DCIS, 35.0% vs 21.6%) types than the healthy CRM group (p = 0.017). 35.0% (n = 14) of patients had en bloc resection; 25.0% (n = 10) of surgical specimens were correctly oriented. En bloc resection and orientation of surgical specimens enable precise pinpointing of the CRMc. A salvage lumpectomy may be proposed as an option when margins are invaded. The histological distribution of the 40 CRMc (mean size 12.7 mm) was carcinoma in situ (CIS) 70%, ILC 12.5%, invasive ductal carcinoma (IDC) 12.5% and tubular carcinoma (TC) 5.0%.

Photography in plastic surgery is omnipresent. Through its various uses, it may present both ethical and forensic risks. The objective of this study is to analyze the use of medical photography by the plastic surgeon, the perception of this use by the patient, and consequence of such use.A questionnaire about the use of medical photography was assessed to 629 plastic surgeons. A questionnaire was given to patients, about their perception of the use of photography by their surgeon.One hundred and seventy-six surgeon's questionnaires and 93 patient's questionnaires were analyzed. For 97.7% of the responding surgeons, the proportion of patients refusing to be photographed was less then 1/20. The objective of the photography was especially medicolegal for 62.5% of the surgeons, especially for following the patient progress (87.5%), partially for the formation (72.1%), partially for scientific publications (57.8%) and not at all for the personal publicity (73.1%). Surgeons often share his photographs with others surgeons (71.1%), sometimes with others medical personnel (48.8%). The security and the access to photographs were determined to be correct for 67.6% of the surgeons and perfect for 23.3%. In total, 17.2% of the surgeons obtained a written consent, 41.4% obtained an oral consent, and 38.5% did not request patient consent. It was found that 48.3% of the surgeons and 40.2% of the patients think that the right to the photographic images belong to the patient.Medical photographs expose the plastic surgeon to medico-legal risks. He must know and follow the law in order to prevent eventual legal proceedings.

INTRODUCTION:Ewing's sarcoma (ES) is a malignant bone neoplasm that develops during the first two decades of life, and affects male more than female patients (sex ratio 1.6/1). ES head and neck bone localization is extremely uncommon (2 to 4%). We report a rapid induced membrane reconstruction without primary bone autograft. OBSERVATION:A 7-year-old boy presented with a 50mm mandibular ES centered on the horizontal branch of the right mandible. This patient was treated by a combination of neo-adjuvant chemotherapy, surgery, and adjuvant radio-chemotherapy, according to the Euro-Ewing 99 protocol. The right horizontal mandibular branch was resected, following induction chemotherapy. A macroplate and a cement spacer were used for the reconstruction, while expecting anatomopathological results. Seventeen days later, we removed the spacer because of scar disunion. The radiographic controls revealed a spontaneous osteogenesis along the macroplate despite the early cement spacer removal. This spontaneously bone growth allowed avoiding a free vascularized bone transfer for the reconstruction. The tissue regeneration potential of this young boy and the cement spacer induced membrane could explain this spontaneous osteogenesis phenomenon. DISCUSSION:Induced membrane can be added to the therapeutic options for pediatric oncologic mandibular bone loss. It avoids using of a free vascularized bone transfer.