Background. - Day surgery is developing and its popularity is increasing for a variety of reasons: economic constraints, changes in professional practices, a greater adhesion of the patient. In an era of progress in surgical procedures, pedicled-perforator flaps reducing donor site morbidity and avoiding micro-anastomosis could take their place in Day surgery if planned and managed by an experienced team. Methods. - In the period January 2019 to January 2021, we performed perforator flaps for soft tissue coverage in ambulatory setting. The patients were included retrospectively and data were collected by reviewing the medical records. Major and minor complications were recorded. Results. - The retrospective cohort included 32 surgical procedures in 32 patients. In all cases, perforator flaps were realized for resurfacing soft tissue defects consequent to oncodermatology surgery (84.3%), soft tissue sarcoma surgery (12.5%), invasive ductal breast carcinoma (3.1%). Major complications needing a surgical revision overcame 3/32 times (9.4%). In these cases, a failure requiring the drop off the flap overcame once. The average wound healing time was of 33 days (15-90) and the mean duration of follow-up was 9.6 months (1-22). Conclusion. - The low complication rate in our series suggests that this first experience on perforator flaps in outpatient surgery is promising in terms of safety and feasibility. Day surgery could be a practical option for this type of surgical procedures avoiding the conventional department's saturation and allowing the delivery of proper surgical cares. (c) 2024 Elsevier Masson SAS. All rights reserved.

BACKGROUND:The advent of propeller flaps has permitted new and less invasive coverage solutions for thoracic defects compared to conventional flaps. Through a retrospective analysis of our cases, we would like to show the advantages of the internal mammary artery perforator (IMAP) flap for anterior chest wall reconstruction. METHODS:We included patients who underwent anterior chest wall reconstruction with an IMAP propeller flap in the Toulouse University Hospital's plastic surgery department from January 2019 to December 2022. The data were collected on patient data, skin defects, and flap characteristics. RESULTS:Twenty-three IMAP flaps were realized to cover locoregional defects. The skin paddle size of the IMAP flap averaged 15.6cm long (12-20)×6.7cm wide (4-10). The average arc of rotation of the flap was 113.5° (range 70-140°). In 3 cases, the IMAP flap was performed with a superior epigastric artery perforator flap (SEAP). In 3 cases out of 23, the flap partially necrotized, requiring surgical revision. In 1 case, the flap was fully necrotized and had to be removed. DISCUSSION AND CONCLUSION:Our series of 23 IMAP flaps on thoracic reconstruction is one of the largest published to date. Our series shows that the IMAP flap offers a simple and reliable solution with minor donor site morbidity for reconstructing small to medium-sized defects in the medial and paramedian regions of the chest wall.

When preservation of the nipple-areolar complex (NAC) is not possible in oncologic breast surgery, the traditional approaches are either a horizontal incision centered on the NAC resulting in visible scars and breast distortion, or a round block with risk of healing difficulties. To address these concerns, the authors propose a star approach technique for skin sparing mastectomies and lumpectomies of central breast tumors. During the oncologic surgery, the NAC is removed with four cutaneous extensions, which can be closed as a cross-shaped scar. The scarring is similar in size to the original NAC diameter and can easily be covered by the NAC reconstruction. This technique offers good exposure during surgery, a good aesthetic result with limited scarring, no breast deformity, correction of breast sagging, and high-quality healing.

La abdominoplastia es uno de los procedimientos más realizados en cirugía plástica. Los progresos en cirugía plástica, en particular de la lipoaspiración y el desarrollo de la cirugía bariátrica, permiten en la actualidad tratar de forma satisfactoria a los pacientes que consultan por secuelas del adelgazamiento o de la gestación. La cirugía de la pared abdominal, tanto estética como posbariátrica, forma parte integrante de la especialidad de cirugía plástica y responde a una fuerte demanda de los pacientes, no sólo estética, sino sobre todo funcional. El adelgazamiento, en ocasiones muy intenso, permite en determinadas condiciones realizar un tratamiento quirúrgico dirigido a rehabilitar las alteraciones corporales debidas a los excedentes cutáneos que quedan como secuela. Aunque está perfectamente estandarizada, conviene no olvidar que esta cirugía no está desprovista de riesgos. La técnica tradicional, cuyo principio es una resección cutaneoadiposa del sector infraumbilical, seguida del estiramiento de un colgajo abdominal supraumbilical con ayuda de un despegamiento del área supraumbilical más o menos amplio, siempre está de actualidad. El conocimiento y el tratamiento de las posibles complicaciones son tan importantes como la propia cirugía. El objetivo de este artículo es exponer la evolución de los conceptos y las técnicas modernas de dermolipectomía abdominal anterior y total circular.

Vulvar loss of soft tissue leads to urinary, sexual and morphological dysfunctions. Most patients affected are comorbid making it difficult to perform a flap, which is the most appropriate way to reconstruct. Our multidisciplinary plastic and gynecologic surgery team has developed a new technique using a pedicled internal pudendal island flap. Reconstruction is reliable, quick and applicable to all patients, with a highly satisfactory final appearance.

L’addominoplastica è una delle procedure più eseguite in chirurgia plastica. I progressi nella chirurgia plastica, in particolare la liposuzione e lo sviluppo della chirurgia bariatrica, consentono attualmente di gestire in maniera soddisfacente i pazienti che chiedono una consulenza medica per postumi di dimagrimento o di gravidanza. La chirurgia della parete addominale, sia essa estetica o postbariatrica, è parte integrante della nostra specialità e soddisfa una forte richiesta da parte dei pazienti, non solo estetica ma soprattutto funzionale. Il dimagrimento, a volte importante, dà diritto, sotto certe condizioni, a un trattamento chirurgico volto a riabilitare il corpo alterato dall’eccesso cutaneo conseguente. Anche se è perfettamente standardizzato, non bisogna dimenticare che questo intervento non è privo di rischi. La tecnica tradizionale, il cui principio è una resezione cutanea del grasso del settore sotto-ombelicale e poi lo stiramento di un lembo addominale sopraombelicale mediante uno scollamento più o meno esteso dell’area sopraombelicale, è ancora attuale. La conoscenza e la gestione delle possibili complicanze sono importanti quanto l’intervento stesso. L’obiettivo di questo articolo è quello di esporre l’evoluzione dei concetti e delle moderne tecniche di dermolipectomia addominale anteriore e totale circolare.

L’avènement des lambeaux libres a permis d’aborder des chirurgies reconstructrices de plus en plus complexes. De nombreux patients ont pu bénéficier au préalable de traitements chirurgicaux extensifs, d’une première reconstruction par lambeau libre et/ou d’irradiation cervicale. Ces traitements entraînent de profondes modifications anatomiques et peuvent altérer la qualité des tissus. Le chirurgien reconstructeur peut alors être confronté à une situation où le choix des vaisseaux receveurs est limité. À l’extrême, des patients présentent un désert vasculaire cervical dans 7 % des cas. Pour les anastomoses veineuses, les branches de la veine jugulaire interne et la veine jugulaire externe sont préférentiellement utilisées. Mais celles-ci peuvent avoir été liées ou être inutilisables. La congestion veineuse est l’une des causes les plus fréquentes d’échec dans ces situations. L’utilisation de la veine céphalique est une alternative décrite pour la réalisation d’une seconde anastomose en première intention. Mais elle reste rare pour le sauvetage précoce d’un lambeau libre. À partir d’un cas, la technique de la transposition de la veine céphalique est illustrée pour le sauvetage précoce d’une reconstruction cervicofaciale par double lambeau libre. La transposition de la veine céphalique est une technique simple, fiable et rapide. Elle doit faire partie de l’arsenal du chirurgien reconstructeur cervico-facial.

The advent of free flaps has made it possible to undertake increasingly complex reconstructive surgeries. Many of the patients have already undergone extensive prior surgery, primary free flap reconstruction and/or cervical irradiation. These treatments strongly impact anatomy and tissue quality. The reconstructive surgeon may be faced with a situation where the choice of recipient vessels is limited; in 7% of cases, no cervical vessels are available at all. For venous anastomosis, branches of the internal and external jugular vein are preferentially used, but may have been ligated or be unusable. Venous congestion is one of the most common causes of failure in these situations. The cephalic vein has been described as an alternative for second anastomosis in first line, but is rarely used for early free-flap salvage. Based on a case study, the technique of cephalic vein transposition is illustrated for early salvage of a double free flap for head-and-neck reconstruction. This technique is simple, reliable and rapid. It should be part of the armamentarium of the head and neck reconstructive surgeon.

BACKGROUND:Extravasation of chemotherapeutic agents is a common complication in cancer centers. In severe cases involving large tissue necrosis, surgery may be needed to resect necrotic tissues and to cover the exposed areas. CLINICAL CASE DESCRIPTION:A 71 years old women was referred to our unit two month after extravasation of epirubicin from an implanted port-a-cath with a large chemonecrosis of the anterior chest wall. She presented an evolutive tissue necrosis extending from the upper anterior thoracic region to the right breast. Surgical debridements and negative wound pressure therapy were necessary in order to obtain clean areas. The final chest wall defect was covered using a Muscle Sparing Latissimus Dorsi pedicled flap. This surgical management have permitted a satisfying wound healing and functional recovery without any complication. CONCLUSION:Chemotherapeutics' extravasations can be a severe complication of oncologic treatment and have to be discussed between oncologists and plastic surgeons to find the most effective and suitable solution with consideration of the specificities of cancer therapy. In chest wall skin defect, the use of muscle sparing latissimus dorsi pedicled flap is a robust solution with low morbidity of the donor site.

Background. - The management of bone exposure in patients with extensive burns could be a challenge due to the lack of healthy tissue. In such cases, it could be interesting to use any still healthy tissue initially destined for amputation and use it to cover up another site. We present the case of a sever burn patient for whom we used the only healthy palmar hand skin to cover an olecranon exposure. Clinical case description. - A 38-year-old man has been admitted in burn victim unit with extensive deep burns on 60% of the total body surface. An exposure of the left olecranon was appeared occurring on a burned area, with absence of healthy local tissues available for coverage. Concomitantly a trans-radial amputation was indicated because of severe digits burns leading to an impossibility to preserve the function of the hand. A palmar skin area was healthy leading to harvested this palmar skin flap pedicled on ulnar vessels. Early post-operative healing was satisfactory and no vascular suffering of the flap has been observed with a total healing at three weeks. Conclusion. - In any patient the spare tissues concept should be keep in mind when amputation is indicated simultaneously with a problematic of loss of substance coverage to a proximity area. In this case of severe burn patient, we used a palmar skin flap pedicled on the ulnar vessels to cover an olecranon exposure. (C) 2021 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Radiation therapy may cause a range of side effects of the skin within the irradiated area. Not of all the reactive effects of the skin induced by radiation therapy have to be related to some forms of radiodermatitis, and when non-standard clinical presentations overcome, it may be necessary to undertake appropriate diagnostic tools to not be in trap of wrong diagnosis. CLINICAL CASE DESCRIPTION:A 76 years-old man undertook resection surgery after a neoadjuvant radiation therapy for a soft tissue sarcoma of his groin region. After surgery, he developed an acute skin reaction comparable with a severe form of radiodermatitis. Despite cares, his clinical status got worse. Only skin biopsies guided us to the right diagnosis: it was a form of a bullous pemphigoid induced by radiation therapy. The consequent appropriate treatment was finally resolute. CONCLUSION:These forms have to be recognized in time, to undertake skin biopsies as soon as an evocative clinical presentation appears. The appropriate treatment, which consists in local or systemic corticotherapy, is resolute in most cases.

several specific the of report, we describe the basic submental free flap technique for vascularized lymph node transfer for the treatment of lower limb lymphoedema. This technique may be used by head and neck surgeons performing flap harvest, as well as plastic surgeon surgeons or gynaecologists long-term management of these patients.

Following a long period dominated by random fasciocutaneous flaps or muscle flaps, solutions to cover the lower limb have been largely diversified by the advent of so-called “perforator” flaps. Extended knowledge of vascular anatomy has propagated the development of this innovative procedure, in the objective of reducing morbidity. The existence of close to 400 perforator vessels in the body makes it possible to offer new flap perspectives for many defects, which were sometimes previously impossible to manage before except by free flap. For us, perforator flaps have become the current first-line solutions for small to medium size loss of substances. Understanding of vascular physiology and surgical experience are essential in choosing indications, detecting perforators, and modeling flaps to be optimally positioned in the reconstructive decisional algorithm. New skills are needed to master this type of reconstruction and limit failures, which implies a learning curve not only for flap design, perforator detection and surgical procedure, but also for monitoring and management of complications. In this manuscript, we outline the concepts and principles of the majority of the pedicled perforator flaps available for coverage of the lower limb, based on experience of more than 400 perforator flaps suitable for this localization.

Limb lymphoedema is common in patients who have undergone inguinal or axillary lymph node dissection. Lymphoedema seriously impacts the patient's quality of life by inducing adipogenesis, fibrosis and repeated episodes of lymphangitis and cellulitis. Following failure of compression therapies, several curative or symptomatic surgical options have been proposed over recent decades, such as liposuction or lymphovenous anastomosis. Vascularized lymph node transfer techniques have recently been described, with promising results. Vascularized lymph node transfer with submental free flap appears to be the most reliable of these technique, associated with the lowest morbidity. The flap harvesting technique presents several specific differences compared to conventional submental free flap. A good knowledge of neck anatomy is essential and multimodal and multidisciplinary management is often required. In the light of a case report, we describe the basic submental free flap technique for vascularized lymph node transfer for the treatment of lower limb lymphoedema. This technique may be used by head and neck surgeons performing flap harvest, as well as plastic surgeon surgeons or gynaecologists ensuring long-term management of these patients. (C) 2019 Elsevier Masson SAS. All rights reserved.

Le lymphœdème des membres est une situation fréquente chez les patients ayant bénéficié d’une chirurgie inguinale ou axillaire carcinologique. Il s’agit d’un état pathologique impactant fortement la qualité de vie de ces patients, par l’adipogénèse, la fibrose et les lymphangites et cellulites répétées qu’il engendre. En cas d’échec des mesures de pressothérapie, plusieurs types d’intervention chirurgicale ont été proposés, que ce soit à visée curative comme les anastomoses veino-lymphatiques ou symptomatique avec des lipoaspirations. Des techniques de transfert ganglionnaire vascularisé ont récemment été décrites, avec des résultats prometteurs. Parmi celles-ci, le transfert ganglionnaire par lambeau libre sous-mental semble la technique la plus fiable et la moins morbide. Sa technique de prélèvement présente des spécificités par rapport au lambeau sous-mental classique. Une bonne connaissance anatomique de la région cervicale est nécessaire, au sein d’une prise en charge souvent multimodale et multidisciplinaire. À partir d’un cas, nous décrivons ici la technique de base du transfert ganglionnaire vascularisé sous-mental pour le traitement du lymphœdème de membre. Il s’adresse aussi bien aux chirurgiens spécialistes de la région cervicale pouvant être amené à en réaliser le prélèvement, qu’aux chirurgiens plasticiens ou gynécologues prenant en charge ces patients au long court.

Flap reconstruction techniques are increasingly desired by French's patients and it represents almost half of breast reconstruction indications in 2017. The main reasons of this statistics are the growing concerns of the patients with breast implant of developing BIA-ALCL, as well as their desire of having a more natural reconstruction results without having any foreign bodies. The multiplication of autologous reconstruction techniques, especially microsurgical techniques which has been popularized in the recent years, makes possible to propose a reconstruction to the majority of patients without an implant. This type of reconstructions is associated with a significant number of complications; thus, a proper selection of patient should be done and a good knowledge of the surgical technique by the surgeon to reduce the complication. Our proposed study is divided into two main parts, the complications of the flap and the complications at the donor site. Based on the experience of our plastic surgery department in immediate and delayed breast reconstruction, the objective of this article is to describe and to analyze the possible complications of breast reconstruction by a flap and their surgical management in intra and post operatively. Our goal is to provide an algorithm for our young colleagues in order to obtain better understanding of this type of interventions difficulties and to provide an appropriate care in the event of complication, also to provide optimal care to the patients who wish to undergo autologous flap reconstructions. (C) 2019 Elsevier Masson SAS. All rights reserved.

Ectodermic dysplasia (ED) is used to designate a group of pathological conditions characterized by congenital defects that involved two or more of the ectodermal-derived structures, comprising sparse hair (hypotrichosis), abnormal or missing teeth (hypodontia or anodontia) 1 Nakayama Y. Baba Y. Tsuji M. Fukuoka H. Ogawa T. Ohkuma M. et al. Dentomaxillofacial characteristics of ectodermal dysplasia. Congenit Anom. Févr. 2015; 55: 42-48 Google Scholar and inability to sweat (hypo or anhidrosis). Anomalies including breast or nipples are also described.