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Significant weight loss, achieved through bariatric surgery, anti-obesity pharmacological treatments, or intensive lifestyle modifications, is frequently associated with cutaneous and morphological sequelae leading to dermatological complications, functional limitations, and a significant psychosocial impact. Reconstructive plastic surgery (abdominoplasty/body lift, limb contouring, breast or cervicofacial procedures) improves comfort, body image, and quality of life, but it carries a risk of complications that requires careful patient selection, weight stabilization, and nutritional optimization. Access to care depends on medico-administrative criteria and documentation of functional limitations. Integration into multidisciplinary care pathways aims to ensure efficient and equitable management. L’amaigrissement important, obtenu par chirurgie bariatrique, traitements pharmacologiques de l’obésité ou modifications intensives du mode de vie, s’accompagne fréquemment de séquelles cutanées et morphologiques responsables de complications dermatologiques, de limitations fonctionnelles et d’un retentissement psychosocial significatif. La chirurgie plastique reconstructive (abdominoplastie/body lift, plasties des membres, gestes mammaires ou cervicofaciaux) améliore le confort, l’image corporelle et la qualité de vie, mais au prix d’un risque de complications imposant une sélection des patients, une stabilisation pondérale et une optimisation nutritionnelle. La prise en charge dépend de critères médico-administratifs et d’une documentation des limitations fonctionnelles. L’intégration dans des parcours multidisciplinaires vise à assurer une prise en charge efficiente et équitable.
The intraoral anastomosis technique (IAT) is an approach that consists of performing microvascular anastomoses within the oral cavity. It avoids cervical incisions and oro-cervical communication. Although widely described using the facial pedicle, its application to the lingual pedicle remains poorly documented. This study aims to describe the surgical anatomy, technical feasibility, and clinical relevance of IAT using the lingual vascular network for tongue reconstruction following partial glossectomies and hemiglossectomies. A detailed review of tongue anatomy and vascularization was conducted, emphasizing the deep lingual and sublingual arteries and veins. A surgical protocol for IAT using thin fasciocutaneous free flaps was developed. One illustrative clinical case of mobile tongue reconstruction using a free superficial circmflex iliac artery pertorator (SCIP) flap with IAT is presented. The deep lingual artery and vein were identified intraoperatively and used for successful microanastomoses with a free SCIP flap. Postoperative outcomes demonstrated optimal flap viability and successful functional rehabilitation. IAT using the deep lingual or sublingual pedicle may be a feasible and functionally effective alternative for tongue reconstruction after type II and IIIa glossectomies. This surgical protocol enables minimally invasive full-thickness reconstruction thereby facilitating optimal functional rehabilitation with reduced surgical invasiveness. In selected patients, lingual IAT enables quality tongue reconstruction with thin free flaps while reducing surgical invasiveness. Further anatomical and clinical studies with larger cohorts are warranted to validate its routine application.
Kabuki make-up syndrome (KMS) is a rare genetic disorder characterized by distinctive facial features and multiple congenital anomalies. Although the facial phenotype is central to diagnosis, the spectrum of oral and maxillofacial manifestations has not been comprehensively summarized. The aim of this study was to systematically review the craniofacial, oral, and dental features associated with KMS. This systematic review was conducted in accordance with PRISMA guidelines. Searches were conducted in 5 databases supplemented by citation chasing and gray literature, using the terms ["Kabuki syndrome" AND ("maxillofacial" OR "orofacial" OR "craniofacial")] up to December 2025. All primary studies reporting oral and maxillofacial manifestations in patients with KMS were eligible, including prospective or retrospective cohort studies and case series comprising at least three patients. The robvis tool was employed for critical appraisal of the studies. Thirty-three articles were included, comprising a total of 424 patients. The most frequently reported craniofacial features were long palpebral fissures (94 %), prominent ears (82 %), and external ear anomalies (76 %). Oculopalpebral anomalies were highly prevalent, including eversion of the lower eyelids (79 %), arched eyebrows (76 %), and sparse or notched lateral eyebrows (77 %). Common nasolabial features included short nasal septum (85 %), depressed nasal tip (80 %), and tented upper lip (60 %). Oral and dental manifestations were also frequent, notably abnormal dentition (58 %), high-arched palate (54 %), and cleft lip and palate (38 %). KMS is associated with a consistent and recognizable pattern of craniofacial and oral abnormalities. Early identification of these features is essential for timely diagnosis. Multidisciplinary management, including early referral to oral and maxillofacial surgeons, orthodontists, and dental specialists, is recommended to address functional impairments and guide craniofacial development. CRD420261353922.
This study provides a large-scale clinical validation of a non-invasive method to characterize the mechanical properties of tumoral and non-tumoral human skin, aiding dermatological diagnosis and establishing a database for future research. The non-contact UNDERSKIN device employs Fourier transform calculations to analyze surface wave dispersion generated by a focused airflow, via a skin-specific inversion model combined with a viscoelastic model. This digital palpation technology provides detailed insight into subsurface particle motion, revealing new mechanical responses of basal cell carcinomas (BCC). Conducted ex vivo on over 160 BCC and 40 healthy skin specimens, the results quantify the viscoelastic behavior of each skin layer. Although dermatologists can assess tissue firmness through palpation, they currently cannot objectively quantify it or determine its origins. This technique provides that missing quantification, linking tactile perception to specific biomechanical properties. By measuring where firmness originates within skin layers, this work offers valuable support for improving diagnosis, prognosis, treatment planning, surgical decisions, and the advancement of teledermatology applications.
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.
Assessing the biomechanical properties of soft tissues can be useful because they are related to their pathophysiological state. This study explores the application of artificial intelligence (AI) to an Impact-Based Analysis Method (IBAM) to predict the mechanical properties of soft tissues. 40 agar-based soft tissue phantoms with different stiffness were prepared. For each phantom, Young's modulus was estimated using dynamic mechanical analysis and IBAM measurements were performed. Various AI-based models were applied to the results obtained with the IBAM approach to predict Young's modulus. Principal component analysis shows that three parameters can explain 85% of the variation in IBAM data. The times of the different maxima of the force signal peaks are significantly correlated with Young's modulus (R2 = 0.99). Most AI-based models allow a decrease in the prediction error compared to the standard IBAM approach (from 5.4% down to 1.2%). Decision trees and ensemble stacking, as well as convolutional neural networks, show a decrease in the prediction error of 74% and 50%, respectively. Applying AI approaches within the IBAM framework is a powerful approach to identify Young's modulus of soft tissues. This study paves the way for using AI-based methods to characterize superficial soft tissue biomechanical properties.
BACKGROUND Gluteal augmentation has gained significant popularity worldwide, with a parallel increase in complications related to unregulated procedures. The use of permanent fillers by non-medical personnel poses serious risks and can complicate future surgical interventions. CASE REPORT We report the case of a 29-year-old woman seeking revision of a prior gluteal augmentation performed abroad with subcutaneous silicone implants. The patient desired greater upper-pole projection and improved contour. During liposuction of the lower back, an unexpected gel-like material was encountered throughout the subcutaneous tissue of the lower back, hips, and infra-gluteal fold, consistent with previously injected permanent filler. The procedure was immediately adapted: fat grafting was abandoned due to the risk of infection and poor graft viability, and thorough manual extraction and irrigation were performed. Implant exchange was completed successfully, with new biconvex silicone implants placed in intramuscular pockets. The postoperative course was uneventful, and at 3-month follow-up, the patient demonstrated improved contour and was satisfied with the outcome. CONCLUSIONS This case illustrates the need for accurate preoperative evaluation and the ability to adapt intraoperatively in response to unsafe prior procedures. It also highlights the growing concern over illegal filler use and reinforces the importance of regulation, patient education, and adherence to evidence-based surgical practices to ensure safety and satisfactory outcomes.
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.
Microtia is a common feature of several human syndromes affecting the external ear (pinna), yet the cellular and molecular mechanisms remain poorly understood. Using human embryos and mouse models of branchio-oto-renal (BOR) and 22q11.2 deletion syndromes, we show that the syndromic genes Eya1 and Tbx1 are expressed in mesoderm-derived auricular muscle. In Eya1 mutant mice, auricular muscles failed to form and pinna morphogenesis was disrupted, with comparable defects observed in mesoderm-specific Tbx1 mutants. Both mutant pinnae exhibited impaired cartilage differentiation, suggesting that auricular muscle provides signals to the neural crest-derived mesenchyme to regulate cartilage differentiation. In contrast, defects in cartilage development alone or loss of muscle contraction did not affect early pinna morphogenesis. Auricular myocytes expressed Fgfs, while the surrounding mesenchyme expressed Fgfr1, Fgfr2 and ERM proteins. Disrupted Fgf signalling was observed in mutant cartilage and muscle. In ex vivo cultures, inhibition of Fgf or Bmp signalling recapitulated cartilage defects, whereas BMP4 restored Sox9 expression. These findings identify the mesoderm as essential for pinna initiation and morphogenesis, and reveal signalling mechanisms underlying microtia in BOR and 22q11.2 deletion syndromes.
To investigate the clinical tolerance and performance of personalized porous titanium implants (PTIs) used on the craniofacial skeleton. Retrospective study. International multicentric study. Adult patients who received PTIs during a 7-year period were included. The primary outcome was the presence of the PTI at the last visit without surgical revision. Local and systemic infections, implant removal, fixation device failure, exposure, re-intervention, and adverse events were assessed at the last visit. We also analyzed risk factors for implant failure. Ninety patients (36, 33, and 21 in the skull, midface, and mandible groups, respectively) with 97 craniofacial PTIs were followed up for a mean of 2.46 years after surgery. At the last visit, 73 patients (81.1%) still had their implant. Overall success rates were 97.2%, 78.8%, and 57.1% for the skull, midface, and mandible groups, respectively. Most complications and implant removals occurred in the mandible group and irradiated patients. On the whole cohort, radiotherapy was associated with a > 4-time higher risk of failure. This study demonstrated an acceptable PTIs overall benefit-risk profile. However, we recommend a careful selection of patients, taking into account anatomical site and treatment history.
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Primary cutaneous amebiasis is a rare manifestation of Entamoeba histolytica infection, often underdiagnosed due to its uncommon occurrence. To report a new case and analyze epidemiological, clinical, and diagnostic data through a review of the literature. A 23-year-old female patient presented with a cutaneous lesion on the left thigh. The diagnosis of primary cutaneous amebiasis was confirmed by histological examination. Any atypical cutaneous lesion, particularly in individuals living in endemic areas, should raise the suspicion of amebiasis. Histology remains the key examination for establishing the diagnosis of this rare form, thereby allowing appropriate management.
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.
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.
This article aims to provide recommendations on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), caused by textured breast implants. These recommendations are based on both updated data from the literature and the experience gained in the management and treatment of patients by the French-speaking Adult Lymphoma Study Group, Lymphoma Study Association (LYSA), regarding BIA-ALCL. Studies indexed in PubMed, focusing on breast surgery and breast implant-associated lymphoma, published between 2006 and 2024, were included. The most relevant articles were analyzed to synthesize recommendations and determine the incidence, clinical presentation, risk factors, various therapeutic approaches, and follow-up strategies. Surgeons who implant breast prostheses must be aware of the specific risks associated with these medical devices. Short-term risks must be considered just as carefully as long-term risks. Technical modifications made by manufacturers to medical devices may introduce unexpected risks. Beyond the usual safety and regulatory procedures for introducing a medical device to the market, appropriate patient monitoring and the reporting of adverse events are essential prerequisites for causality investigations and potential corrective measures.
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.
The submental flap, first described by Martin and Baudet in 1990, was originally developed for the reconstruction of defects involving the lower two-thirds of the face. Owing to its reliable vascular pedicle and anatomical proximity, its indications have progressively expanded to include complex soft-tissue losses of the hemiface, particularly at the oral commissure, where both aesthetic and functional demands are high. We report the case of a 70-year-old patient presenting with a right cheek and labial commissure defect following an animal bite, associated with loss of the modiolus and orbicularis oris muscle sling. Reconstruction was performed in two stages: (1) restoration of the orbicularis continuity and coverage of the defect using an insular submental flap pedicled on the right submental artery, and (2) secondary commissuroplasty four months later to restore labial continence and facial symmetry. The first stage achieved complete coverage of the composite defect and reestablishment of muscular continuity. Following commissuroplasty, the patient recovered satisfactory labial motility, oral opening, and functional continence. Subsequent staged debulking procedures refined the aesthetic outcome while maintaining flap trophicity and hair-bearing skin texture. This case highlights the reliability and versatility of the submental flap in commissural reconstruction. Its favorable skin characteristics, robust vascularization, and wide arc of rotation make it an effective alternative to heterolabial flaps, allowing a "like-with-like" reconstruction that achieves both durable functional recovery and harmonious aesthetic integration.
Cherubism is a rare paediatric bone disease caused by gain-of-function mutations in the SH3BP2 gene. This condition is characterized by osteolysis of the jaw bone, which can be sometimes massive, whereby bone is replaced by fibrous tissue containing osteoclast-like multinucleated giant cells. Recently, a patient with a severe cherubism was reported to have, in addition to the craniofacial cherubism features, a low bone mass phenotype. To determine whether this patient was the exception or the rule, the cherubism phenotype was explored in ten more patients outside the cranio-facial. For the first time, inflammatory and bone blood markers together with bone density and growth in height and weight were systematically assessed in relation to the radiological and NFATc1 location classifications. We observed normal weight and height in the patients, as well as a significant increase in the bone metabolism blood markers (especially CTx and P1NP), which was associated with the severity of the cherubism. Our analysis also highlights the need for more systematic assessments of cherubism patients to improve our understanding of the cherubism natural history.
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