共找到 20 条结果
Breast surgery, regardless of the type of procedure, requires a symmetrical result. However, this outcome is currently dependent on the surgeon's experience and subject to their subjectivity. Our study aims to investigate the correlation between the weight of breast gland resection and the volume variation measured by a portable 3D camera, adjusted for breast density measured electronically. Thirty patients who underwent bilateral breast reduction were included in the study. Each patient had her breast volume measured using a 3D camera (GOPRO by Creaform) during the preoperative consultation and again four months postoperatively. For each patient, breast density was measured using the MyotonPro device. Analysis of the correlation between the resection weight and pre- and postoperative volume variation revealed a coefficient of determination r2 of 0.822 (95% CI: 0.713-0.892). Adjustments based on the parameters measured by the MyotonPro did not appear to influence the correlation. Our model indicates that for a resection weight≥500g, there is a volume variation of 666mL, with a sensitivity of 85.3% and a specificity of 86.4%. There is a strong correlation between the resection weight and the volume variation measured by the 3D camera, with no influence from breast density. The routine use of a 3D camera would allow plastic surgeons to better plan each surgery and optimize our results.
The adverse effects of breast implants, especially silicone breast implants, are increasingly being shown. In addition to complications related to surgical technique and individual patient factors, the implant aging is suspected of being one of the main causes. This study employs the Raman technique, a label-free, non-destructive method that provides chemical composition information, to clarify the structure of the membrane and its gel-bleeding prevention function. The results identified two important markers-diphenylsiloxane and CH3 vibration-that can distinguish the degradation state of silicone breast implants before and after implantation. In addition, two Raman bands at 1159 and 1524 cm-1, indicative of gel yellowing, were identified, providing potential insights into the permeation of external substances into the gel through the membrane. The results are consistent with previous observations and highlight the potential of deep learning models to determine degradation time thresholds based on these identified markers.
Commensal bacteria interact with each other and their environment, secreting anti-microbial peptides, bacteriocins, and extracellular vesicles (EVs). Cutibacterium acnes (C. acnes), a commensal bacterium that plays a major role in acne, is classified into different phylotypes (IA1, IA2, IB, IC, II, and III), where overabundance of phylotype IA1 relative to other phylotypes is found in acne lesions. EVs secreted by C. acnes phylotype IA1 extracted from an acne lesion were previously found to induce a pro-inflammatory response in skin models. Here, we investigated the effects of Myrtus communis extract (Myrtacine) and Celastrol-enriched extract (CEE), anti-inflammatory ingredients, alone or in combination, on cutaneous innate immunity induced by C. acnes IA1 EVs. This study was conducted under preventive and modulating conditions: Myrtacine alone, CEE alone, or in combination were added to the culture medium either prior to (preventive) or after (modulating) incubation with C. acnes IA1 EVs from healthy and acne skin in immortalized keratinocytes (HaCaT) and human skin explants. Then, regulation of β-defensin 2 (hBD2), interleukin (IL)-6, IL-8, IL-17α, and IL-36ɣ was assessed. Preventive and modulating applications of Myrtacine and CEE significantly reduced expression of the five immune markers induced specifically by EVs from acne-derived C. acnes IA1. Our results show that C. acnes EVs may be a target of Myrtacine and CEE. They can down-modulate the pro-inflammatory activity induced by EVs derived from C. acnes IA1 from acne skin, showing the interest of these ingredients at both preventive and modulating levels in the treatment of inflammatory acne.
Robotic nipple-sparing mastectomy (RNSM) is becoming popular for the treatment of breast cancers because of the absence of scars on the breasts. The aim of this study is to assess the feasibility and the safety of RNSM with immediate prosthetic breast reconstruction (IPBR). In this single-arm, monocentric and prospective study, RNSM with IPBR was offered, in case of prophylactic or therapeutic surgery of breast cancers, to patients with breast cup≤C and moderate ptosis. The primary goal was the rate of full thickness skin or areola necrosis. As a second objective we meant to assess the rate of conversion to open technique and postoperative complications. We also analysed pre- and postoperative BREAST-Q scores and aesthetic outcomes by submitting them to independent surgeons and to the patients themselves. In total, 138 RNSM with IPBR were performed in 79 patients between December 2015 and January 2020. There were two cases of full thickness skin or areolar necrosis (1.5%), nine infections (6.5%), and nine implants loss (6.5%). We had to switch to an open technique in two cases (1.5%) and in four cases we had to surgically drain four hematoma (2.9%). The patient's physical and sexual well-being evaluated by BREAST-Q was not impacted by the surgery. The aesthetical outcomes are satisfying for both the patients and the main surgeon as well as for a panel of independent plastic surgeons. This study does attest to the feasibility, the reproducibility, and the safety of this approach.
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.
Neuroscience work on our aesthetic judgment skills shows that the neurocognitive mechanisms involved are far from being as basic and automatic as one might think. Aesthetic pleasure can thus be broken down into three complementary layers: sensory, memory and analytical pleasure. In multivariate models of creativity, several components are also considered: cognitive, conative, emotional, and environmental or social. Neuroimaging studies show that there are common brain networks mobilized for aesthetic judgment and creativity tasks, which helps explain why, if we ask people to perform creativity tasks, we notice that this then stimulates their aesthetic sensitivity, and vice versa.
Surgery for pelvic-trochanteric pressure ulcers requires complex multidisciplinary management. Perioperative complications are common, as are distant recurrences. Perforator flaps are currently widely used for this indication, with the main advantages being that they avoid muscle sacrifice, reduce skin detachment in useful perforasomes, and shift the skin tension associated with remote removal of the pressure ulcer. We conducted a systematic review of the literature and a retrospective study of patients treated in two French expert centres over the last nine years concerning the complication and recurrence rates of fasciocutaneous, musculocutaneous and perforating flaps. We used these data to propose a treatment algorithm for the use of perforator flaps in the therapeutic arsenal. Out of 1210 publications studied, 92 articles were selected covering 4105 patients. The overall complication rate was 23.9% (CI 95% 23.44-24.42) and the recurrence rate was 12.4% (CI 95% 11.90-12.82) with a significant advantage in both cases for perforator flaps. We included in our cohort study 416 flaps performed on 399 patients with spinal cord injuries between 2015 and 2024. A significant reduction in the recurrence rate was observed with the use of a perforator flap (OR 0.47 [0.30; 0.74], P=0.001). Perforator flaps are an indispensable solution in the current therapeutic arsenal for pelvic-trochanteric pressure ulcers coverage. More reliable and reducing long-term recurrence, they do not replace other types of flaps, which remain highly indicated. Our algorithm allows for the use of different types of flaps with a view to preserving muscle and skin in a population at risk of recurrence.
Post-traumatic wrist stiffness after intra-articular distal radius fractures rarely improves with hardware removal alone once arthrofibrosis is established. Arthroscopic arthrolysis allows minimally invasive release of intra-articular adhesions. Arthroscopic arthrolysis combined with hardware removal improves wrist motion and function compared with hardware removal alone. This single-center prospective study compared arthroscopic arthrolysis with hardware removal (combined) versus hardware removal alone (isolated) in patients with post-traumatic wrist stiffness after intra-articular distal radius fracture fixation. Outcomes were assessed preoperatively and at 1 year. The primary outcome of the study was the improvement in the flexion-extension arc. Secondary outcomes included changes in radial and ulnar deviation, pronation and supination and functional scores (QuickDASH). Forty patients were included (15 combined, 25 isolated). At 1 year, flexion-extension gain was significantly greater in the combined group (32.6° vs 6.4°; p < 0.001). QuickDASH improved significantly only in the combined group. No major complications occurred. Arthroscopic arthrolysis combined with hardware removal provides superior improvement in wrist motion and function compared with hardware removal alone and should be considered in patients with established post-traumatic wrist stiffness. III.
Beyond any initial surprise, the involvement of street artists in healthcare facilities, on commission, is helping to transform these places, particularly those dedicated to caring for children. By breaking with the classic aesthetic expected of a hospital room, medical waiting room, etc., street art, in its various forms and universes, provides valuable sensory and emotional experiences in this very special context. Without replacing medical care (which is not its purpose), this artistic expression helps to create a warmer, more positive atmosphere, that benefits young patients, their families, and caregivers alike.
Peripheral Arterial Disease (PAD) is a prevalent but underdiagnosed pathology. Soluble CD146 (sCD146) was described as a marker of endothelial dysfunction and vascular congestion. We hypothesize that sCD146 may represent a novel biomarker of PAD. Our objective was to evaluate the association between plasma sCD146 levels and the occurrence and severity of PAD. In this case-control study, 184 Caucasian men with symptomatic PAD were compared to 163 age-matched healthy control patients. PAD diagnosis was confirmed using ankle-brachial index (ABI) and imaging. Plasma sCD146 was quantified using ELISA. Associations with clinical and biochemical parameters were analyzed through multivariable logistic regression models. sCD146 level was significantly reduced in PAD patients (mean [95% CI]: 288 ng/mL [269-306]) versus control patients (480 ng/mL [460-500], p < 0.0001). A 10 ng/mL decrease in sCD146 was associated with an age-adjusted odds ratio (OR) of 1.17 (95% CI 1.13-1.22) for PAD, increasing to OR 1.25 (95% CI 1.14-1.36, p < 0.0001) after adjustment for risk factors. sCD146 was not associated with PAD severity (by Fontaine stage). Notably, the association between sCD146 and HDL-C was positively correlated in controls (β = 0.220, p = 0.005), but negatively correlated in PAD patients (β = - 0.156, p = 0.041), with significant interaction (p = 0.002). Age-adjusted OR for PAD was highest in individuals with high HDL-C tertiles (OR = 1.41, 95% CI 1.22-1.63). A lower sCD146 concentration is independently associated with PAD. Additionally, an inverse relationship was observed between HDL-C and these patients. These findings suggest that sCD146 may reflect impaired endothelial homeostasis and metabolic dysregulation in PAD, indicating that it could serve as a diagnostic biomarker for the pathology. NCT00377897.
Cutaneous nasal defects, often resulting from surgical excisions for cancerous, traumatic, or congenital lesions, represent a major challenge in reconstructive surgery. The aim of this single-center retrospective study was to evaluate surgical practices and factors influencing the choice between two reconstruction techniques : the nasolabial flap (NLF) and the folded paramedian forehead flap (PFF) according to Menick's technique. Between January 2017 and March 2024, 23 patients with full-thickness alar defects, with or without extension to the nasal tip, were included. Patients were divided into two groups : 13 underwent PFF and 10 underwent NLF. Demographic data, comorbidities, histological type (primarily basal cell carcinomas), and aesthetic and functional outcomes were analyzed. PFF was associated with a significantly higher number of aesthetic subunits reconstructed (2.6±0.8 vs. 1.3±0.4, P<0.001) and a greater number of surgical stages (3.6±1.1 vs. 1.4±0.7, P<0.001). Patients in the PFF group were primarily motivated by aesthetic considerations (66 %), while those in the NLF group prioritized the speed of the procedure (50%). An anonymous questionnaire was distributed to 63 head and neck surgeons to explore their preferences and reasons for their choices. The NLF was preferred by 84% of surgeons, mainly due to its simplicity and speed, while 49% opted for the PFF, despite its complexity and the social inconvenience caused by the pedicle before division. The main drawbacks of the PFF were the number of surgical stages (49%), social inconvenience (35%), and donor site scarring (29%). However, the aesthetic outcomes of the PFF were considered superior, particularly for defects involving more than one aesthetic subunit. The use of pre- and postoperative photographs to guide patients was more common among experienced surgeons (57%). In conclusion, although the NLF is more widely used due to its practicality, the PFF remains the technique of choice for complex defects, offering optimal aesthetic results despite its complexity. Clear information and the use of visual aids are essential to assist patients in their decision-making process.
The primary objective of this study is to assess the inter-observer agreement in the analysis of digital flap photos using the Pixacare application. The secondary objective is to evaluate the implementation of outpatient telemonitoring for these flaps via the Pixacare application. This is a prospective monocentric study conducted at SOS Main Lesquin from January 1st to July 1st, 2023. Patients who underwent a digital flap procedure were included in the study. Home care nurses were asked to send a weekly photo of the flap via the Pixacare application. The collected photo sequences were then analyzed by three observers and classified into two categories (normal healing/complication). Patient satisfaction with the follow-up was rated on a scale of 5. A total of 27 patients were included, with 76 photographic sequences collected via the application. Fleiss' Kappa coefficient, evaluating inter-observer agreement, was calculated at K=0.64, 95% CI [0.51; 0.77], with P<0.001, indicating strong agreement. The average patient satisfaction score was 4.63/5. The follow-up of digital flaps using the Pixacare application appears promising in reducing the frequency of consultations, given the strong inter-observer agreement. While patient satisfaction is very high, the implementation of this telemonitoring system will require some adjustments to ensure strong adherence from paramedical staff to photographic follow-up.
Pelvic-perineal necrotic bacterial dermohypodermitis, also known as Fournier's gangrene, is a rare infection, at 1.6/100,000, affecting males in more than 95% of cases, frequently overwhelming and with very poor prognosis. It is polymicrobial in more than 80% of cases, spreading rapidly in the subcutaneous perineal tissue due to bacterial enzymes. Recent mortality estimates were between 7.5 and 20%. The main risk factors, related to impairment of immunity and microcirculation, include diabetes, smoking and alcohol abuse, obesity, HIV infection, cardiac, renal and/or hepatic comorbidity, and cancer. Diagnosis is primarily clinical. Presentation typically associates fever, intense pain, scrotal edema, cutaneous erythema and subcutaneous crepitation, with possible rapid progression to septic shock. Prognostic scores have been developed, but their use should never delay implementation of abdominal-pelvic CT and surgery. Debridement needs to be carried out early, within 12hours of symptom onset; mortality is increased 3-fold if the delay exceeds 14hours: 24 versus 69%. Management is sequential and multidisciplinary, associating hemodynamic stabilization, broad-spectrum probabilistic antibiotic therapy, and iterative "skin-sparing" debridement, which improves the rate of delayed primary closure (7 vs. 38%; P=0.002) and hospital stay (26 vs. 46 days; P=0.02), and facilitates secondary reconstruction.
Martin's first description of the submental flap in 1990 (Martins, 1990) made it possible to reliably cover the lower two-thirds of the face. Although deemed difficult due to its intricated vascular, muscular and nerve anatomy, this flap has quickly gained in popularity. Its increasingly frequent use has made it possible to describe dissection steps at the level of the facial vessels and venous drainage system to gain arc of rotation. However, to date, no study has measured the gain in arc of rotation related of the dissection performed. To find out the gain in arc of rotation depending of the dissection performed at arterial and venous level. We also describe the course of the submental artery in relation to the anterior belly of the digastric muscle. Twelve flaps were made on six fresh cadavers, previously injected with colored latex. Measurements were taken with a reference line between the external canthus and the root of the helix. Of the eleven flaps including the submental artery, dissection of the facial artery to its origin at the level of the external carotid artery resulted in an average gain of 2.3cm. The YV venous lengthening resulted in an additional average gain of 0.8cm. In all cases, the submental artery was located deeper than the anterior belly of the digastric muscle. Pedicle elongation techniques include dissection of the facial artery to its origin, as well as YV venous procedure. The choice should be dictated by the area to be covered. The gain in arc of rotation is substantial after dissection of the facial artery and appears moderate and technically difficult with venous lengthening.
From the fetal period onwards, integrated sensory perception lays the foundations for aesthetic experience. In infants, social interactions and multisensory experiences promote attentive engagement with the world, based on the body and the senses. There is currently little research on babies' aesthetic sense, but numerous scientific studies reveal the importance of their multisensory skills for learning. We can therefore hypothesize that aesthetic sense is a driver of human development.
Lip augmentation is a procedure frequently performed by cosmetic physicians, as well as cosmetic and reconstructive surgeons. Atrophy of the lips and the surrounding areas or even in the perioral region is often the result of malformations related to insufficient development of structures during embryogenesis, but also the consequence of tissue aging, which affects patients unequally. The general principle of lip and midfacial augmentation involves injections using needles or cannulas that directly puncture the skin at certain strategic points, in order to correctly position the substance intended to increase tissue thickness. One of the adverse consequences of this approach is sometimes excessive augmentation, which occurs even unintentionally, as it is difficult to precisely control the amount to be injected, even with extensive experience. This is why an alternative approach, which is not new, consists of performing these injections, in certain indications, not transcutaneously but rather intraorally. This approach has already been used for around thirty years by a number of surgeons, notably by a French school of aesthetic surgery and medicine. The depth of the injection is therefore of some interest because it allows for less transformation of the face, since the product will be deposited in contact with the periosteum or soft tissues but relatively far from the skin or labial mucosa. In this technical note, the principles of this deep intraoral injection are detailed, and results are presented as well as rare complications.
The earliest descriptions of septoplasty date back to the 18th century. Modern techniques, including disarticulation septoplasty, aim to correct complex septal deformities while preserving nasal function and aesthetics. Our study evaluates the functional and aesthetic outcomes of this innovative approach. We conducted a single-center retrospective study including 7 patients who underwent surgery between 2024 and 2025 for unilateral nasal obstruction with characteristic "watch glass" septal deviation. The surgical technique was based on three fundamental principles: meticulous bilateral dissection of the fibromucosal flap using ethmoid-vomer landmarks, complete disarticulation of the quadrangular cartilage including its caudal, vomerine and ethmoidal release, followed by anatomical repositioning stabilized with silicone splints. Outcomes were assessed by comparing preoperative and 3-month postoperative NOSE and NAFEQ scores using Wilcoxon tests (R software v4.1.3). Analysis revealed significant functional improvement, with mean NOSE scores decreasing from 15.4±2.4 preoperatively to 6.0±5.9 postoperatively (P=0.022). Aesthetically, NAFEQ scores showed global improvement from 38.75±8.1 to 58.1±8.1 (P=0.014), with significant enhancements in both functional (P=0.025) and aesthetic (P=0.03) subscores. No major complications such as septal perforation or saddle nose deformity were observed in our series. Quadrangular cartilage disarticulation septoplasty represents a significant advancement in managing complex septal deviations. It effectively combines resolution of nasal obstruction (61% NOSE score reduction), satisfactory correction of columellar deviations (50% NAFEQ score improvement), and demonstrated short-term safety. These promising results warrant confirmation through randomized comparative studies with longer-term follow-up.
暂无摘要（点击查看详情）