This clinical case report describes the reconstructive management of a child who developed a rare aggressive soft tissue infection - necrotizing fasciitis - complicating varicella skin lesions, with a synthetic dermal regenerative template - NovoSorb Biodegradable Temporizing Matrix - in conjunction with a split thickness meshed skin graft. The scarcity of this clinical case, the need to cover large skin defect promptly while facing infectious and pediatric challenges make it interesting to describe NovoSorb Biodegradable Temporizing Matrix in addition to split thickness meshed skin graft a novel treatment in necrotizing fasciitis of the child. A rapid surgical treatment followed by this reconstructive strategy achieved an acceptable functional and aesthetic result, with timely healing despite the severity and extensive surface area of the infection.

Total nasal reconstruction represents a complex challenge, requiring restoration of all three anatomical planes while preserving respiratory function. This procedure has significant therapeutic, aesthetic, social and professional implications for patients. We share our academic experience of reconstruction using a folded microanastomosed radial forearm flap (FRFF) combined with a paramedian forehead flap, using the technique of F.J. Menick. We detail the technical aspects of this surgical approach, as well as the aesthetic results observed at the donor sites. In our single-center retrospective study, we analyzed 6 cases of total nasal reconstruction performed between January 2017 and January 2024. We assessed the typology of substance loss, types of reconstruction, and aesthetic results via the NAFEQ score at 6 months postoperatively. Among the cases, necrosis was observed (16%), occurring on the fourth day following thrombosis. Mean loss of substance was 5.5cm, with a mean NAFEQ functional score of 82% and aesthetic score of 88%. The FRFF reconstruction technique combined with LFP is optimal for total nose reconstructions, offering adequate cartilage projection and good nostril conformation.

Vertical rectus abdominis myocutaneous (VRAM) flap is the most common option for large sacral defect reconstruction but is known to have donor-site abdominal morbidity compared to deep inferior epigastric perforator (DIEP) flaps.

Esophagus reconstruction could be complicated by leakage, stenosis or graft loss. Salvage surgery may be needed in case of failure of endoscopic treatment or large esophagus defect. Although free jejunal flap is admitted for salvage head and neck reconstruction, few reports assess the results of free jejunal interposition in salvage esophagus reconstruction. We undertook a systematic review whose primary aim is to investigate outcomes of secondary esophageal reconstruction with free jejunal flap in terms of mortality, complications and functional results.

Hydrogen sulfide (HS) is a widely studied gasotransmitter, and its protective effect against ischemia-reperfusion damage has been explored in several studies. Therefore, a requirement exists for a comprehensive study about HS effects on ischemia-reperfusion damage in flap surgery. The aim of this study is to examine the effect of hydrogen sulfide by creating ischemia-reperfusion injury in the vascular-stemmed island flap prepared from the rat groin area.

Phalloplasty is one of the most complex procedures in plastic surgery. The criteria for an ideal neophallus include an aesthetic and erogenous phallus that allows for sexual intercourse, with a functional neo-urethra enabling standing urination. The free forearm flap has become the gold standard for phallic reconstruction. Various modifications have been made to improve vascularization and reduce urinary complications, such as fistulas and urethral stenosis. Each design has its advantages and disadvantages, with the goal of minimizing functional and aesthetic sequelae in the donor area while achieving the most satisfactory result in the recipient area. Over the years, several prominent surgeons have proposed different forearm flap designs, always with the aim of improving outcomes and patient satisfaction.

Unicortical plate fixation offers several theoretical advantages in the treatment of metacarpal shaft fractures compared to bicortical fixation. This approach avoids the potential hazard of excessive drilling into the volar cortex, thus minimizing damage to surrounding soft tissues and helping prevent complications related to improperly sized screws. These benefits prompted our team to conduct a preliminary clinical study to investigate the effectiveness and safety of this approach. In this study, we present our initial experience assessing the efficacy of utilizing unicortical plate fixation for treating metacarpal shaft fractures.

Facial lipoatrophy, a sign of normal aging, also occurs due to lipodystrophy from metabolic disorders affecting lipogenesis. It can be hereditary or acquired, localized or generalized. In HIV patients, prolonged antiretroviral therapy (ART) is a major cause, affecting around 55% of patients with 47% experiencing facial lipoatrophy. The exact changes in adipose tissue in HIV patients are unclear. Atrophic areas show immature adipose tissue, inflammation, and increased apoptosis. NRTIs cause mitochondrial toxicity, leading to energy depletion and adipocyte apoptosis. PIs disrupt protein expression related to adipocyte metabolism, causing apoptosis and metabolic issues. Lipoatrophy leads to fat loss in the cheeks, temporal, and sub-zygomatic regions, resulting in a cachectic appearance. Despite severe lipoatrophy, Bichat's fat pad often remains unaffected. Various scales assess lipodystrophy severity: James Scale, Fontdevilla Scale, Funk Scale, Facial Lipoatrophy Scale. Facial lipoatrophy significantly impacts patients' quality of life, leading to poor body image and depression. The MOS-HIV and ABCD questionnaires assess the impact on quality of life. Several therapeutic options are described: antiretroviral switch, growth hormone, glitazones, excision and suturing, human cadaveric dermis and Fascia, dermafat, fillers, lipofilling, implants and flaps.

The anterolateral thigh flap is sometimes harvested with a portion of the quadriceps muscle fascia, which can lead to muscle hernias or adhesions at the donor site. Studies report an 11 to 32% incidence of muscle hernias and an 8 to 26% incidence of persistent weakness at the donor site. There is no data in the scientific literature presenting a surgical technique for the prevention of muscle hernias at the donor site of the anterolateral thigh flap. The objective of our study is to describe our technique for placing a synthetic mesh when closure of the fascia is not possible during the harvesting of an anterolateral thigh flap, in order to reduce the risk of postoperative muscle hernias and to analyze its benefits.

In the literature, we do not find any published study on the clinical signs of thermal skin burns in the acute phase in black-skinned patients. The present study, which fills this gap, reports for the very first time the results of clinical observations in 214 black-skinned burn victims. This was a prospective study that collected the clinical signs of burns in the acute phase. This study included all burn patients with black skin who consulted in the acute phase without initial local treatment and whose burn was less than 4hours old. It covered a period of 13 years, from January 1st, 2011 to December 31st, 2023. Males (54.6%) and children aged 5 years and under were the most affected (46.3%). Boiling liquids were the most common causative agent (67.4%). Burns of 20% or more of the body surface area represented the largest proportion (39.1%) followed by those between 10 and 19% (35.5%). All 214 patients included in the study had at least one first-degree burn and there were several associated degrees. Second-degree burns, as a whole, were also among the most encountered, i.e. 89.1% of cases. In our burn patients with black skin, we observed some clinical differences in the assessment of burn depth with the description reported in the literature. The erythema described in first-degree burns on "white" skin was reflected in the burned patient with black skin by a dark, darker or grayish appearance of the skin; and the dermis for second- and third-degree burns appeared whiter in patients with black skin compared to patients with "white skin". The semiology of thermal skin burns in the acute phase should be revisited and adapted to the patient's skin color.

Vascularized composite allografts (VCA) encompass the face, upper limb, trachea, penis, abdominal wall, and, more recently, uterus transplants. They offer unique reconstructive possibilities to overcome the limitations of traditional reconstructive techniques. Unlike solid organ transplants (heart, liver, kidney, lung, etc.), VCA is not generally performed in a life-threatening situation but aims to improve quality of life, at the cost of a major constraint to its expansion: the need for lifelong immunosuppressive treatment. Nevertheless, VCA is considered one of the five most important innovations of the modern era of the discipline, and a worldwide survey of plastic surgeons has confirmed that significant changes in reconstructive surgery will be related to VCA in the future. France pioneered this type of transplantation by successfully performing the first VCA (unilateral hand transplant), the first double hand transplant, the first face transplant, the first face retransplant, and the first bilateral shoulder and arm transplant, and continues to demonstrate unprecedented surgical prowess. This activity continues to expand across the country, with active VCA programs notably in the upper limb, face, uterus and penis. This article aims to provide an update on the clinical advances made in France in the field of composite tissue allografts.

Sensibility of the breast area is a key factor in quality-of-life evaluation after breast reconstruction (BR). Breast sensation can be assessed using numerous tools that are already largely described in the literature, including the Semmes Weinstein filaments which remain the most frequently used. Although different reconstruction techniques are available, post-BR sensitivity is rarely described. The aim of this study was to evaluate post-BR sensibility of the breast according to each reconstruction technique.

In Africa, rare publications have focused on phyllodes tumors (PTs). The aim of our study is to describe the special feature of PTs surgery.

Patients who underwent cleft lip surgery in childhood may develop nasal malformation later in life. Various procedures have been described to correct these malformations. This study aims to describe our surgical approach and assess the morphometric outcomes of secondary cleft-lip rhinoplasty performed at the plastic surgery department in Marseille between 2002 and 2022. We conducted an analysis of surgical procedures and nasal morphometrics results by measuring pre- and postoperative images. Both surgical procedures and nasal morphometric analyses have been performed. This study included 43 patients, with 70% presenting unilateral cleft lip and 30% bilateral cleft-lip. An open approach was performed in 90% of cases. Regarding the surgical steps, a tip rhinoplasty, tip reinforcement, and crus lateral reinforcement by cartilage grafting was performed in 98%, 96%, and 32% of cases. A septal extension graft, a columellar strut, and a "tongue in groove" technique were performed in 54%, 33%, and 4% of cases, respectively, to reinforce the tip. Cartilage harvested from the nasal septum, ribs, and ear was utilized in 44%, 23%, and 20% of cases. An osteotomy, septoplasty associated with a spreader-flap, alar base reduction, and alar to triangular cartilage fixation were performed in 67%, 79%, 16%, and 16% of cases. All pre- and postoperative nasal morphometrics measurements have demonstrated a statistical significant improvement in nasal morphology following surgery. An open approach rhinoplasty, facilitating alar cartilage dissection and reinforcement by septal, rib, or ear cartilage is crucial to preserve postoperative outcomes. Our technique enables favorable mid-term results on secondary cleft-lip rhinoplasty.

Traumatic injuries and penetrating traumas of the upper limb are at high risk of combined neurovascular lesion, due to anatomical proximity of main vessels and nerves. Occasionally, post-traumatic pseudoaneurysms or thrombi can develop in the site of trauma or surgery; these vascular complications represent a real urgency and require an accurate and timely diagnosis. The neurophysiological investigation still represents the gold standard for quantification, localization of nerve injuries and outcome prediction.

Hyaluronic acid (HA) non-surgical procedures are increasingly popular, with approximately 5.6 million performed annually by plastic surgeons worldwide. These treatments effectively address signs of aging in the forehead and nasofrontal areas but come with risks such as bruising, swelling, infections, inflammation, granulomas, skin necrosis, and vascular obstructions. The nose, forehead, and glabella are particularly high-risk areas for visual changes and embolic complications. The nasofrontal region's vascular network is supplied by branches from both the external and internal carotid arteries. The external carotid artery includes the lateral nasal, columellar, and angular arteries, while the frontal branch of the superficial temporal artery supplies the temporal and lateral frontal areas. The internal carotid system, via the ophthalmic artery, includes the supratrochlear, supraorbital, and dorsal nasal arteries, supplying the central and middle forehead and upper nasal dorsum. These networks form a robust vascular arcade. Patients with vascular complications from facial injections often present with a reticulated skin pattern, hematoma, ecchymosis, tenderness, pain, pressure, and sometimes scabs or pustules. Specific skin patterns are associated with vascular complications in defined facial areas. A structured treatment protocol using targeted ultrasound-guided hyaluronidase injections effectively manages these complications, emphasizing a detailed understanding of vascular anatomy and precise diagnostic tools.

The aesthetics of the periorbital region are significantly influenced by the position of the eyebrows, forehead wrinkles, and upper eyelid ptosis, with aging-related eyebrow ptosis playing a major role. Brow lift surgery has seen a marked increase in popularity, driven by a variety of techniques tailored to individual patient needs. The 'gliding brow lift' technique, which employs a minimally invasive subcutaneous approach using a hemostatic net, represents a recent advancement in eyebrow rejuvenation. This article outlines our three-year experience and adaptation with this technique, which is divided into three sequential steps: (1) subcutaneous dissection; (2) internal eyebrow fixation; (3) skin redraping. Our modified gliding brow lift technique combines simplicity, minimal equipment requirements, conservative principles that limit scarring and avoid skin resection, and long-lasting results with few complications, making it an attractive option for brow rejuvenation.

The forehead lift is designed to raise the eyebrows and reduce forehead wrinkles to rejuvenate the face. Since 1991, endoscopic surgery has revolutionized forehead lift techniques, bringing significant improvements in both cosmetic and reconstructive surgery. This article aims to present the indications and techniques of fronto-temporal plastic surgery, detailing the frontal and temporal areas. The study includes operations using an endoscope, a light source, a video camera, and a monitor to transmit images. Subperiosteal and supraperiosteal incisions and dissections are performed, followed by temporal and frontal suspensions. The advantages of endoscopy include reduced scarring and a lower risk to hair follicles. The main disadvantages primarily concern the difficulty of muscle excision. Endoscopic forehead lift remains a preferred technique for long-lasting results, despite advancements in botulinum toxin. It offers precise and durable aesthetic corrections, justifying its importance in cosmetic surgery.

Peripheral facial palsy (PFP) is an alteration in the functioning of some facial muscles following an injury to the facial nerve. This pathology has functional and aesthetic consequences that impact the quality of life of patients. Their care is essential and begins with an accurate assessment. Currently, scoring scales such as Sunnybrook Facial Grading System (SFGS) or House-Brackmann Grading System (HBGS) are used, based on clinician judgment. However, these evaluation methods can be subject to a certain degree of subjectivity. Recent advances in technology have led to increased interest in artificial intelligence (AI). AI could make it possible to develop an objective, automated and quantitative assessment tool, applicable in a clinical setting. This approach aims to reduce the subjectivity induced by current evaluation. We conducted a retrospective study of 38 patients with moderate-severe to total PFPs. The objective of the study is to identify the benefits and limitations of Emotrics+, a facial metrics tool based on AI, in order to determine whether the tool is applicable in the clinic. This protocol took place at two different time periods (14days and 1year post-PFP) using the SFGS scale and the Emotrics+ software. We evaluated the inter-rater and intra-rater reliability in order to determine the reliability and the reproducibility of the two tools. Then, we established a correlation between the two tools to determine if Emotrics+ followed SFGS's trend. Our currents results do not support the immediate applicability of this software. However, with appropriates adjustments, Emotrics+ has a certain potential.