Background Pseudoxanthoma elasticum (PXE) is a hereditary disorder of connective tissue characterized by progressive calcification and fragmentation of elastic fibers, which primarily affects the skin, retinal and arterial walls. Skin damage takes the form of yellow papules that can merge to create a cutaneous fold. This is accompanied by an excess of skin on the different sides of the neck and in the largest folds. These changes to the skin have a significant aesthetic, functional and psychological impact, especially among women. Patients and methods We evaluated the treatment options in all patients with PXE of our University-Hospital. This group contains people who have been hospitalized for the assessment of their disease and applicants for surgical correction. The goal of the surgery was not the total removal of the lesions but instead a decrease in their size and a tightening of the skin. Results In total, 250 patients were seen between 2007 and 2022. Surgical treatment was advised for 29 women and 1 man. The main interventions were based on standard techniques such as cervico-facial facelifts, brachioplasties and cruroplasties. The results obtained during postoperative follow-up consultations were rated satisfactory to very good, both aesthetically and functionally. There were no postoperative complications recorded: neither bruising nor scarring issues. Patients with PXE heal as normal. Conclusion Surgical treatment for excess skin observed during PXE is poorly described. Yet, these excesses can be removed when they become troublesome by making use of and adapting the traditional methods of plastic surgery for tightening of the skin.

Multi-tissue injuries to the foot are common in the pediatric population. Microsurgical repairs are part of the therapeutic arsenal in pediatric reconstructive surgery. We report the case of a 4-year-old boy involved in a lawnmower accident resulting in complete amputation of the hallux, soft tissue damage, and exposure of the calcaneus and first metatarsal. A combined free flap repair using muscle-sparing latissimus dorsi and serratus anterior was performed. The patient was reviewed at 3 months and 1 year with radio-clinical and podoscopic examination. Weight bearing on the foot and on the flap was completely restored without skin fragility. Aesthetics were assessed using a numerical scale and foot function using the American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome Score (FAOS) scores. The results of these scores were good, with a clear improvement at 1 year. Repair of the traumatic foot in children requires a robust surgical strategy to restore function and aesthetics to this complex organ. Our combined free flap of muscle-sparing latissimus dorsi and serratus anterioris are the only ones described in the literature. It appears to be a reliable treatment option, with no morbidity and good functional results.

BACKGROUND:Subtotal and total lower eyelid tissue loss after tumour excision is a complex issue for reconstructive surgeons. The anterior and posterior flaps must be restored to avoid compromising the functional and aesthetic prognosis of the eye. This study used a septal chondromucosal graft for the posterior lamella and a fasciocutaneous flap pedicled on the temporal artery for the anterior lamella. METHOD:We conducted a 10-year monocentric retrospective study, including 18 patients who were treated using a septal chondromucosal graft with a temporal artery pedicle flap following tumour excision. We collected demographic and medico-surgical data related to flap survival, absence of ectropion, lagophthalmos and other post-operative complications. The aesthetic outcome was judged using a grading scale during the last follow-up consultation. RESULTS:All grafts and flaps survived, whereas 2 patients required early repeat surgery (1 for ectropion and 1 for graft site haematoma). None of the patients developed lagophthalmos. Two patients had distal flap injuries that healed with local care. All patients were satisfied with the aesthetic outcome at the last follow-up visit. CONCLUSION:Combining a septal chondromucosal graft with a fasciocutaneous flap pedicled to the temporal artery for total lower eyelid reconstruction is a reliable method with satisfactory functional and cosmetic outcomes.

Background. - The Face is the most frequent localization for cutaneous carcinoma. The nose accounts for about 30% of these tumors. Nose tissue loss repair has to pursue 3 types of objectives: carcinologic, aesthetic and functional. The aim of this article is to identify a decision tree to guide the choice of surgical reconstruction technique based on localization and size of the defect. Patients and Methods. - We performed a retrospective analysis in Angers' CHU from 2013 to 2019 including 229 patients referred for cutaneous tumors excision in need of reconstruction. We analyzed the type of reconstruction, size of the tissue loss and localization of the defect in terms of nose aesthetic subunits. Results. - Among the 229 patients included, the most frequent localization was nose tip (32%). 44% of patients were reconstructed with skin grafts or composite graft, 56% with flaps (48% local flaps and 4% association of both methods). Limited central resections of nose tip were reconstructed with skingraft. The Rybka flap and bilobed flap were the preferred choice for lateral reconstruction of nose tip. Largest tip defects were reconstructed using Rieger flap or forehead flap. The dorsum was often reconstructed with local flap: glabellar on the upper part, Rieger on the lower part. Lateral side was perfectly reconstructed with island flap. Nose wings needed framework: composite graft was the judicious choice in case of limited tissue loss whereas forehead flap with framework or Schmid-Meyer flap were chosen for larger defects. Conclusion. - Our past experience in nasal reconstruction has provided us with an original decision tree to guide surgeons in choosing the right reconstruction technique according to the size and localization of the defect. (C) 2021 Elsevier Masson SAS. All rights reserved.

Le pseudoxanthome élastique (PXE) est une pathologie héréditaire du tissu conjonctif caractérisée par une calcification et une fragmentation progressive des fibres élastiques, affectant principalement la peau, la rétine et les parois artérielles. L’atteinte cutanée est faite de papules jaunes pouvant confluer en un placard cutané, accompagné d’un excès de peau sur les différentes faces du cou et dans les grands plis. Ces manifestations cutanées ont un impact majeur sur les plans esthétique, fonctionnel et psychologique, en particulier chez les femmes qui constituent 2/3 des patients. Nous avons évalué les options thérapeutiques chez tous les patients appartenant à la cohorte PXE de notre CHU, hospitalisés pour le bilan de leur maladie et demandeurs d’une correction chirurgicale. L’objectif de la chirurgie n’était pas la disparition totale des lésions mais la diminution de leur surface et une remise en tension cutanée. Cent soixante-dix patients ont été vus entre 2007 et 2017. Un traitement chirurgical a été retenu chez 21 patients. Les principales interventions réalisées reposaient sur les techniques de base des liftings cervicofaciaux (9 patients), des brachioplasties (7 patients) et des cruroplasties (5 patients). Les résultats recueillis lors des consultations de suivi postopératoire étaient jugés satisfaisants, tant sur les plans esthétique que fonctionnel. Il n’y a pas eu de complications postopératoires à déplorer : ni hématome, ni troubles cicatriciels à court et long terme. Les patients atteints de PXE cicatrisaient de façon normale. L’atteinte cutanée évoluée du PXE peut être partiellement prise en charge par les procédés classiques de chirurgie plastique, permettant d’augmenter le confort et la qualité de vie de ces patients. Il a été montré que l’atteinte cutanée progressait jusque vers 35 ans, le traitement chirurgical n’est donc à proposer qu’après cet âge, sachant que les lésions ne s’étendent plus beaucoup après. La littérature sur la prise en charge chirurgicale du PXE est pauvre. Une quinzaine d’articles ont été publiés depuis 1943, majoritairement des cas cliniques pour la prise en charge des lésions du cou, plus rarement pour celle des lésions axillaires. La plastie en Z est volontiers recommandée en association au lifting. Elle ne nous paraît pas indispensable. À notre connaissance, aucun rapport sur la région inguinale n’a été publié dans la littérature chirurgicale. Les traitements non chirurgicaux (laser CO2 et injections d’acide hyaluronique) sont également très peu nombreux. L’évaluation de leur intérêt à long terme n’est pas disponible. La prise en charge chirurgicale des excès cutanés observés au cours du PXE est peu décrite. Pourtant ces excès peuvent être retirés lorsqu’ils deviennent gênants, en s’aidant et en adaptant les procédés classiques de chirurgie plastique de remise en tension cutanée.

Objective: The risk of sight-threatening complications related to facial paralysis makes palpebral fissure management a priority. Surgery must take account of and adapt to the clinical signs of paralytic lagophthalmos. This therefore presupposes that a sufficient therapeutic arsenal is available. In this report, we propose a technique for palpebral lengthening (lower and/or upper), reconstructing the posterior lamella using a chondromucosal graft harvested from the nasal septum, combined with anterior lamellar repositioning. Patients and Method: A 5-year single center retrospective study was conducted, including sixteen patients for a total of nineteen septal chondromucosal grafts. The only inclusion criterion was paralytic lagophthalmos. Functional ophthalmic deficits were recorded (main outcome measure), first preoperatively, then postoperatively. Additionally, the degree of lagophthalmos was measured in order to infer palpebral fissure elongation gain. Surgical consequences and complications were recorded. Results: A rapid regression in functional ophthalmic deficits was observed in 87% of patients, improving in stability over time (mean follow-up interval of 34 months). Mean palpebral fissure elongation gain was 3 mm. 53% of patients suffered from complete occlusion of the palpebral fissure. Surgical consequences were uncomplicated. 38% of patients eventually underwent revision surgery. Conclusion: Palpebral fissure lengthening using septal chondromucosal grafts serves as an alternative to existing treatment methods for paralytic lagophthalmos. Robust functional and cosmetic results, combined with very low morbidity, make this a simple and efficient technique whose indications may be extended. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Background: Preserving the integrity of the eyelidmargin in eyelid reconstruction remains a challenge for plastic surgeons. In 1976, Hubner described a technique to repair full-thickness eyelid defects using a tarsomarginal graft covered with a local flap. This simple technique addresses both functional and aesthetic requirements of eyelid reconstruction by using tissue from the contralateral eyelid. The aim of this study was to determine the appropriate role of this uncommon technique in eyelid reconstruction. Method: In total, 94 tarsomarginal grafts were performed on 70 patients. Eight surgeons participated in this study. Data were retrospectively collected from patients' charts and all information regarding surgical indications, histology, defect size and topography, operative time, immediate result, and potential complications were recorded. Results: Only one of the patients suffered total necrosis. Partial wound dehiscence occurred in one case and partial necrosis occurred in 6 cases. No major sequelae were observed in the donor eyelids. In 100% of cases, eyelid margin integrity was otherwise preserved. Four patients required revision surgery for insufficient malignancy resection and 13 patients for long-term eyelid ectropion or scar retraction. Conclusion: This simple and reliable technique ensured the closure of full-thickness eyelid defects covering up to 3/4 of the eyelid length. The procedure should bemore widely used as it guarantees high-quality eyelid reconstruction. (C) 2018 Elsevier Masson SAS. All rights reserved.

Medical photography is an important part of the medical file and is widely used in medical communication, especially in our discipline. His practice has to be the most standardized and reproducible as possible, which distinguishes it from artistic photography. Photography fix the light reflecting from a subject, so surgeon have to control of the light source in any environment. In the absence of dedicated studio, using external cobra or ring flashes with special diffusers allow the surgeon to have light sources adapted to the different conditions encountered in daily practice. (C) 2017 Elsevier Masson SAS. All rights reserved.

Background. Squamous cell carcinomas are malignant tumours of epithelial origin that can appear on sites subjected to chronic inflammation after a period of several years. The rapid development of squamous cell carcinoma at the donor site for a thin skin graft is a rare and poorly understood situation.Patients and methods. We report the case of a patient undergoing thin skin grafting to cover the area of removal of a vertex squamous cell carcinoma and in whom squamous cell carcinoma appeared at the donor site within 9 weeks.Discussion. In our case, we ruled out intraoperative contamination because two sets of surgical instruments were used. Given the number of cases reported in the literature, a chance event seems unlikely. The hypothesis of an acute inflammatory process caused by scarring of the thin skin graft site appears to us the most convincing. Development of cancer at the graft donor site may thus be added to the list of complications of thin skin grafting. (C) 2016 Elsevier Masson SAS. All rights reserved.

The external canthus defects with resection of the superior and inferior eyelids external portion remains difficult to treat. The reconstruction has to focus on both the reconstruction of the tarso-conjunctival plan and the musculo-cutaneous plan but has also to treat the disappearance of the external canthus. Usually the tarso-conjunctival plan is reconstructed by a septal transplant, conqual or of palatine mucous membrane. The technique presented here suggests to use two tarso-conjunctival transposition flaps to reconstruct the external canthus and the canthal external ligament. The palpebral defect is then pulled medialy, and is easily reconstructed by a Hübner's graft. The coverage of these tarso-conjunctival flaps and grafts is realized with local cutaneous or musculo-cutaneous flaps. The aim of this reconstruction is to allow a functional and aesthetic reconstruction with respected lid margins with eyelashes. Thanks to this technique, it is possible to reconstruct external canthus defects up to half of the superior and inferior eyelids.

Nasal lesions, which are often carcinomas, require a histological control of the excision sometimes forcing to postpone the reconstruction source of nasal mutilation disfiguring. Reconstructive procedures have made steady progress and the notion of reconstruction in three planes advocated by Tiersch has been improved in a major way by Millard, Burget and Menick, who added an essential aesthetic dimension. We present our experience in this field by selecting procedures that seem most appropriate and describing the key points of the operating process, which remain the guarantee of both therapeutic and aesthetic success. (C) 2013 Published by Elsevier Masson SAS.

Lip reconstruction can be performed with numerous surgical techniques. The aim was here to present these usual techniques and to focus on the details that can be used to obtain the most favourable results. The goal of this surgery, that represents a compromise between function and aesthetic, has to be kept in mind to prevent mistakes that decrease the quality of the result.

IMPORTANCE:Debate continues about the cause of midfacial growth disturbance in patients with facial clefts.OBJECTIVE:To evaluate the functional effect of surgical closure of the lip before palatal closure according to the technique by Delaire on early maxillary growth in patients with complete unilateral cleft lip and palate.DESIGN, SETTING, AND PARTICIPANTS:Twenty-two patients with unilateral cleft lip and palate were studied using plaster casts obtained at the time of cheilorhinoplasty and 6 months later before palatal closure. The interrupted lateral muscles were anatomically repositioned using the surgical technique by Delaire. No patients had received preoperative orthodontic treatment or a passive palatal plate. Cast analyses were performed using a digital caliper.MAIN OUTCOMES AND MEASURES:Landmark positioning was performed 3 times by 2 different examiners to define intraobserver and interobserver differences. The final maxilla dimensions were recorded as the distances between the mean landmark positions. Using the t test, dimensions obtained before palatal closure were compared with dimensions obtained before lip closure.RESULTS:The method allowed good reproducibility. Functional closure of the lip significantly narrowed the transverse anterior cleft areas by -2.36 mm (P < .05). Sagittal variables were increased by 1.68 mm on the nonaffected side and by 1.48 mm on the affected side (P < .05 for both).CONCLUSIONS AND RELEVANCE:Functional closure according to the technique by Delaire narrows the transverse dimensions of the maxilla, while simultaneously preserving initial sagittal growth.LEVEL OF EVIDENCE:4.

There are many possibilities for nasal skin defect reconstruction. The purpose of this article is to highlight the important points to respect in order to achieve aesthetic results. The principles that must be observed in nasal reconstruction are recalled. The most interesting techniques are detailed and illustrated with clinical cases. (C) 2013 Published by Elsevier Masson SAS.

Nous présentons les différentes techniques de reconstruction de la joue en insistant plus particulièrement sur les plans superficiels. En plus du contexte clinique, la localisation et les dimensions de la lésion seront prises en compte afin de choisir le meilleur procédé pouvant garantir le meilleur résultat fonctionnel et esthétique avec le moins de séquelles possible. Les préoccupations majeures sont l’absence de déformation des orifices naturels périphériques, la localisation et l’orientation des cicatrices, la qualité du revêtement cutané et le respect des volumes.

In eyelid reconstruction, filling the defect is not sufficient. In young patients, the aim is to obtain a reconstructed eyelid, as normal as possible. In elderly patients, the large amount of available skin and the good quality of scars seem to be favorable. But weakening and stretching of the connective tissue and eyelid structures and deficient production of tears may compromise the functional result. In every case, restoring aspect and function are going together. The purpose of this chapter is to show how different techniques may be used in eyelid reconstruction with good cosmetic result. Different cases are carefully described and illustrated.

The purpose of this article is to address the techniques of reconstruction of the forehead and the temple trying to add an "aesthetic'' dimension, as the fourth dimension introduced by Burget for the reconstructive surgery of the nose. Achieve "aesthetic'' reconstruction is to have constant attention to details. This is how to choose the right indication depending on the age and the etiology of the defect. This is to place incisions to perfection. And it is to be humble and open oneself to criticism, always seeking to improve the quality of its results. (C) 2013 Elsevier Masson SAS. All rights reserved.

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.