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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 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.
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Medial canthopexy is a surgical technique that allows correction of the position of the medial canthus, corresponding to the medial angle of the palpebral fissure. Abnormal position of the medial canthus is observed in the case of telecanthus (excessive intercanthal distance) or medial canthal dystopia (displaced medial canthus), encountered in congenital craniofacial malformations or after craniofacial trauma or tumoral resection that affects the orbits. Correcting the position of the medial canthus is a challenge for the training surgeon, due to the difficulty of the techniques. Medial transnasal canthopexy aims to reposition and fix the medial canthal tendon contralaterally with wires. This technique is difficult to realize, due to the need for successive transnasal passages of several wires with limited surgical access, and the small size and fragility of the medial canthal tendon. A learning curve is thus required. To date, literature is scarce concerning the description of the technique for medial transnasal canthopexy, and several variations of the technique are described. We aimed to describe a standardized, reproducible technique for bilateral medial transnasal canthopexy by an orbitonasal approach, based on Paul Tessier's technique, which our team has been experienced with for several years.
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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.
Severe burn injury triggers systemic inflammation that can lead to multiple organ dysfunctions and death. High-dose intravenous vitamin C has been proposed to mitigate these effects, but strong evidence in patients with burn injury is lacking. To evaluate the efficacy of high-dose intravenous vitamin C in patients with severe burn injury. Randomized, double-blind, placebo-controlled phase 3 trial conducted across 24 burn centers in North, Central, and South America; Europe; and Asia. Adults (≥18 years) with deep second- and/or third-degree burns covering 20% or more of total body surface area and requiring skin grafting were enrolled between August 18, 2020, and September 12, 2025. Final follow-up was completed in March 2026. The trial was stopped early after the first prespecified interim analysis for futility/harm. Patients were randomly assigned (1:1) to receive intravenous vitamin C (50 mg/kg every 6 hours for 96 hours) or matched placebo. The primary outcome was a composite of 28-day mortality and persistent organ dysfunction (defined as dependence on mechanical ventilation, kidney replacement therapy, or vasopressor/inotrope support at day 28). The main secondary outcome was time to discharge alive from hospital within 90 days. Among 238 patients enrolled (mean age, 48.9 [SD, 19.1] years; 79% male; mean total body surface area, 37.0% [SD, 14.6%]), 120 were assigned to vitamin C and 118 to placebo. The primary composite outcome occurred in 49 patients (40.8%) in the vitamin C group and 35 patients (29.7%) in the placebo group (adjusted risk ratio [RR], 1.28 [95% CI, 0.99-1.65]; P = .06), crossing the prespecified futility/harm threshold and prompting early trial termination. Time to discharge alive from hospital within 90 days was not improved (adjusted subdistribution hazard ratio, 0.85 [95% CI, 0.62-1.16]; P = .31). Twenty-eight-day mortality was higher in the vitamin C group (15.0% vs 7.6%; adjusted RR, 1.96 [95% CI, 1.32-2.90]; P = .001), as was hospital mortality (23.3% vs 16.1%; adjusted RR, 1.44 [95% CI, 1.03-2.00]; P = .03). Among patients with severe burn injury, high-dose intravenous vitamin C did not reduce 28-day mortality and persistent organ dysfunction and is possibly harmful. ClinicalTrials.gov Identifier: NCT04138394.
Quality of Patient-Surgeon Relationship (Q-PASREL) is a patient-reported experience instrument that assesses dimensions of the patient-surgeon relationship, including empathy, information transfer, communication, and availability. Higher Q-PASREL scores have been associated with improved patient recovery outcomes following upper-limb surgeries. This study, conducted among hand surgeons, examines whether consultation duration influences these scores. A multicenter observational study was conducted, involving 16 hand surgeons from January 2023 to June 2024. For each surgeon, mean consultation duration and mean Q-PASREL score were calculated from patient questionnaires. Correlations were assessed using Spearman's coefficient. A total of 411 Q-PASREL questionnaires were analyzed. Mean consultation duration was 12 min (range 5-20). All surgeons had medium- to high-Q-PASREL scores. Spearman's coefficient between consultation duration and Q-PASREL score was 0.36 (p = 0.169), indicating a weak, statistically non-significant positive correlation. High-quality patient-surgeon relationships, as measured by Q-PASREL, were observed across all consultation durations in hand surgery. Consultation duration was not significantly correlated with the Q-PASREL score. Routine use of Q-PASREL does not require extended consultation times.
Reliable perfusion of the distal portion of free parascapular (PSC) flaps is essential for successful lower extremity reconstruction. We hypothesized that intraoperative indocyanine green near-infrared video angiography (ICG-NIR-VA) enables reliable assessment of distal flap perfusion, thereby supporting microsurgical decision-making and reducing the risk of distal flap necrosis. We conducted a retrospective analysis of all free parascapular (PSC) flaps performed for lower extremity reconstruction between January 2015 and December 2024. Patients were non-randomly assigned to intraoperative perfusion assessment using indocyanine green near-infrared video angiography (ICG-NIR-VA; study group, n = 45) or conventional clinical evaluation (control group, n = 67). In both groups, inadequately perfused flap segments were trimmed intraoperatively at the surgeon's discretion. Primary endpoints were distal or total flap necrosis, while secondary outcomes included reoperation rates and postoperative length of hospital stay (POLHS. Intraoperative use of ICG-NIR-VA guided PSC flap design by identifying poorly perfused distal flap portions in 15 of 45 cases (33%), all of which resulted in uncomplicated postoperative courses. Partial flap necrosis occurred in 3 of 45 flaps (6.7%) in the ICG-NIR-VA group compared to 12 of 67 flaps (18.0%) in the control group (p = 0.09). Overall, intraoperative ICG-NIR-VA showed a strong correlation with postoperative outcomes, reflected by a negative predictive value of 98%. Furthermore, ICG-NIR-VA-assisted reconstructions required fewer recipient-site revision surgeries (9/45 [20.0%] vs. 24/67 [35.8%], p = 0.10) and showed a non-significant trend toward a shorter postoperative length of hospital stay (19 ± 10 vs. 21 ± 11 days, p = 0.40). Our findings suggest that ICG-NIR-VA may support intraoperative decision-making and may be associated with improved clinical outcomes, although several observed differences did not reach statistical significance.
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.
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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.
Reduction mammaplasty is a common surgical procedure in France. Even if the French surgeons were pioneers in this surgery's development, we ignored French plastics surgeons' practices in this domain at this time. The aim of this study was to provide an overview of breast reduction practices among French plastic surgeons in 2024. This is a descriptive, cross-sectional observational study conducted between March and June 2024. A 41-item online survey was distributed to French plastic surgeons, addressing surgeon demographics, indications, surgical techniques, and perioperative management strategies for reduction mammaplasty. A total of 513 plastic surgeons responded. The main preoperative requirements were smoking cessation (89%) and a body mass index (BMI) <30kg/m2 (79%). Preoperative imaging was requested by 90% of respondents. The most frequently employed surgical techniques were the superomedial pedicle (44%) and the superior pedicle (42%), whereas the inferior pedicle was rarely used (1%). Drains were placed by 57% of surgeons, and outpatient surgery was performed by 26%. The most reported early complication was wound dehiscence (61%), while late complications were dominated by suture exposure (59%). To our knowledge, this is the first national cross-sectional online survey describing breast reduction practices in France. Despite the declarative nature of the data, the large number of responses provides meaningful insights into current trends and the evolution of surgical practice.
Craniosynostosis, defined as the premature fusion of one or more cranial sutures, leads to craniofacial deformities and may impair facial growth. Despite early surgical correction, the long-term impact on dento-skeletal development remains insufficiently characterized. This study evaluated the prevalence and determinants of dento-skeletal dysmorphoses (DSDs) in children who underwent craniosynostosis surgery during infancy and were followed until completion of growth. This ambispective study included 95 patients treated surgically for syndromic or nonsyndromic craniosynostosis at Lyon University Hospital between 2004 and 2006. Data were collected on craniosynostosis type, age at surgery, diagnosis and type of DSDs, treatment, and cranial base angle. Descriptive statistics and logistic regression analyses were used to assess prevalence, distribution and risk factors. Among the 95 children, 48 (50.5 %) developed a DSD. This patient had undergone craniosynostosis surgery at significantly older age (8.3 ± 2.9 vs 5.9 ± 2.4 months; Mann-Whitney test, p < 0.001). Trigonocephaly was strongly associated with maxillary transverse deficiency (OR = 4.84; 95 % CI [1.19-19.7]; p = 0.028), while scaphocephaly also showed a higher prevalence (21.1 %) without statistical significance. Scaphocephaly had the highest rate of Class II malocclusion (34.2 %), whereas brachycephaly and anterior plagiocephaly were mainly associated with Class III (100 % and 50 %, respectively). All syndromic cases developed Class III malocclusions. Despite early cranial surgery, craniosynostosis remains associated with altered craniofacial growth and a high prevalence of malocclusions. Older age at surgy was an independent risk factor for DSDs. These findings underscore the importance of systematic, long-term orthodontic follow-up in both syndromic and nonsyndromic patients and suggest that an earlier surgical management may help reduce the risk of subsequent DSD.
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.
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.
Dynamic flexion or extension orthoses for the proximal interphalangeal joint (PIP) are commonly employed in rehabilitation to enhance mobility after trauma. This study aims to compare the biomechanical performance of two commercial extension orthoses (sizes S and L) and a 3D-printed orthosis. The tests were conducted with increasing loads ranging from 0 to 1500 g. Angular displacements were measured using a specific experimental setup. The forces exerted were modeled using simplified assumptions about the geometry of the orthoses and their interaction with the finger. The results show that the 3D-printed orthosis, while offering advantages in customization, exhibited limited mechanical resistance, failing under a load of 700 g. In contrast, the commercial orthoses demonstrated excellent fatigue resistance, with an average angular displacement difference of less than 0.1° between repeated series. The 3D-printed orthosis exhibited the highest slope in the stress-strain curve (13.9°N-1 compared to 9.3 °N-1 and 7 °N-1 for commercial S size and L size respectively). These results indicate that, although of the same order of magnitude, this 3D-printed orthosis is more deformable. In conclusion, commercial orthoses provide better mechanical reliability under the tested conditions, while the 3D-printed orthosis requires improvements. Integrating multi-material components and force sensors could improve durability and efficiency, opening promising perspectives for customized rehabilitation orthoses.
The main aim of this study was to compare functional, pain and clinical outcomes between patients who underwent implant removal combined with total wrist denervation and patients who underwent implant removal alone for painful intra-articular malunion of fracture of the distal radius that was not amenable to osteotomy. This single-centre, prospective study included adult patients with painful intra-articular distal radial malunion non-amenable to osteotomy between 2022 and 2025. Patients were offered either implant removal combined with total wrist denervation (combined group) or isolated implant removal (isolated group). The primary endpoint was a comparison between groups of the postoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and visual analogue scale (VAS) pain scores at 1 year. The secondary outcomes were the comparison of the postoperative range of motion (ROM), grip strength and complications. Overall, 35 patients were included. In the combined group, the QuickDASH and VAS scores were significantly improved at 1 year from 45.5 (IQR: 38.6 to 50.0) to 18.2 (IQR: 13.6 to 27.3) and from 4.8 (SD 1.1) to 1.6 (SD 1.4), respectively. In the isolated group, no significant improvement in the QuickDASH nor in VAS was found. At 1 year, patients in the combined group had a significantly lower QuickDASH score, lower VAS scores and improved grip strength compared with patients in the isolated group. There was no difference between the groups regarding ROM and number of complications. The addition of total wrist denervation during implant removal appears to offer substantial symptom relief and improved function in this population. III.
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.