[Reconstruction of nasal skin defect].

There are many possibilities for nasal skin defect reconstruction. The purpose of this article is to highlight the important points to respect in order to achieve aesthetic results. The principles that must be observed in nasal reconstruction are recalled.

[Aesthetic reconstructive surgery of the lip].

Lip reconstruction can be performed with numerous surgical techniques. The aim was here to present these usual techniques and to focus on the details that can be used to obtain the most favourable results. The goal of this surgery, that represents a compromise between function and aesthetic, has to be kept in mind to prevent mistakes that decrease the quality of the result.

[Full thickness reconstruction of the nasal pyramid].

Nasal lesions, which are often carcinomas, require a histological control of the excision sometimes forcing to postpone the reconstruction source of nasal mutilation disfiguring. Reconstructive procedures have made steady progress and the notion of reconstruction in three planes advocated by Tiersch has been improved in a major way by Millard, Burget and Menick, who added an essential aesthetic dimension. We present our experience in this field by selecting procedures that seem most appropriate and describing the key points of the operating process, which remain the guarantee of both therapeutic and aesthetic success.

[Cheek reconstruction].

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.

[Aesthetic aspects of eyelid reconstruction].

In eyelid reconstruction, filling the defect is not sufficient. In young patients, the aim is to obtain a reconstructed eyelid, as normal as possible. In elderly patients, the large amount of available skin and the good quality of scars seem to be favorable.

[Forehead and temple aesthetic reconstruction].

The purpose of this article is to address the techniques of reconstruction of the forehead and the temple trying to add an "aesthetic" dimension, as the fourth dimension introduced by Burget for the reconstructive surgery of the nose. Achieve "aesthetic" reconstruction is to have constant attention to details. This is how to choose the right indication depending on the age and the etiology of the defect.

[External canthus reconstruction with tarso-conjunctival transposition flap and Hübner's graft].

The external canthus defects with resection of the superior and inferior eyelids external portion remains difficult to treat. The reconstruction has to focus on both the reconstruction of the tarso-conjunctival plan and the musculo-cutaneous plan but has also to treat the disappearance of the external canthus. Usually the tarso-conjunctival plan is reconstructed by a septal transplant, conqual or of palatine mucous membrane.

[Eyebrow reconstruction].

The eyebrow is an essential anatomical area, from a social point of view, so its reconstruction, in case of skin defect, must be as meticulous as possible, with the less residual sequela. Capillary density extremely varies from one person to another and the different methods of restoration of this area should absolutely take this into consideration. We are going to review the various techniques of reconstruction, according to the sex and the surface to cover.

[Schmid-Meyer fronto-temporal flap for nasal reconstruction].

Introduction: Many surgical techniques have already been described to repair full thickness defects of the inferior part of the nose. The Schmid-Meyer fronto-temporal flap procedure, a little known technique, is based on the old principle of autonomization of a cutaneous flap and uses a tailor-made composite cartilaginous graft placed in the temporal region. This graft is progressively detached and allows mucosal/cartilaginous/and cutaneous nasal repair.

[Eyelid, medial canthus and medial orbital wall reconstruction using a combination of Hübner and conchal grafts with two illustrative cases].

Post-ablative medial canthus and medial orbital wall reconstruction may involve various materials. Few articles present such reconstructions using cartilage homografts, and very few opt for conchal cartilage. In some cases of medial orbital wall excision, at least half of the eyelid must also be removed.

[Moldable titanium mesh for chest wall reconstruction, an elegant solution about a case report].

Introduction: Several surgical techniques are available for full thickness chest wall reconstruction. The choice has to be adapted to the size of the loss of tissue, its location, and must finally be accepted by the patient's. We propose a new and unpublished solution.

[Conchal flap with a superior pedicle to reconstruct the middle or upper third of the auricle].

The middle or upper third of the auricle can be reconstructed with a composite chondro-cutaneous peninsular flap of the conchal part of the auricle. This peninsular flap is based on the anastomotic network between the posterior auricular and the superficial temporal artery. The authors report their experience about 24 clinical cases.

[Submental flap for auricule reconstruction].

Objective: We present our experience in the use of submental flap in reconstruction of post-auricular excision defects.

Material And Methods: Three patients underwent reconstruction with submental flap.

Results: The submental flap has been used in 3 patients for auricular defect reconstruction.

[Primitive neuroendocrine cancer of the breast. Post-traumatic discovery of a man].

We report a primitive neuroendocrine breast tumor (NET) in a male. This situation is uncommon by its mode of discovery. We have treated a 74-year-old man with a lesion in the left areola initially considered as an organized hematoma due to a severe trauma.

[The complete dorsum nasal island flap based on the superior alar artery].

The complete dorsal nasal aesthetic unit can be raised in a vascular island flap based on the superior alar artery, at the level of the nasalis muscle. This flap uses the vertical glabellar cutaneous laxity. It hides scars between the nasal aesthetics units and its distal rotation point allows a pure translation of the nasal skin without distortions encountered when using medial canthal rotation flaps.

[Optimized negative pressure therapy. Case report].

Our patient showed major abdominal cutaneous necrosis. Detersion removed the entire thickness of half of the right-hand wall of the abdomen. We are going to explain how, by combining well known procedures, we conducted this closure.

[Abbé-Mustardé's flap with lower lid transposition: three clinical cases].

The ideal solution first recommended is the use of Abbé-Mustardé's flap with lower lid transposition to rebuild the total loss of the upper eyelid. Every step of the surgical technique has been detailed to improve the result and keep the drawbacks under control. After having read articles on this subject, we describe three clinical cases, which enable us to compare with others surgical techniques that cannot rebuild all the levels of the eyelids and the edge of the eyelashes.

[The reversed dermis flap soon to be forgotten as a major filler?].

In his paper entitled "The reversed dermis flap" published in 1978, Pakiam explained the advantages of de-epithelialising local flaps and applying them dermis-side down. We present a ten-year series of 107-reversed dermis flaps used to raise depressed scars. There have been no significant complications in this series except two cases of infection and six cases of postoperative haematoma.

[The orbitonasolabial flap. Anatomical and clinical study].

How to use the orbitonasolabial flap in vascular island thanks to his pedicle based an angular vessel. An anatomic study based on 11 cadavers allows to check the existence of a constant pedicle. This flap was used on 6 patients aged 62 to 90 years old on an average period of 16 months to fill up jugular, orbital, nasolabial and inner canthal defects.

Seven reconstructions of the orbital and periorbital region with a contralateral orbitonasolabial flap.

Blasius designed the first orbitonasolabial flap in 1842, which has since, been reshaped by many other surgeons. Three years ago, we were confronted with a difficult reconstructive case where ipsilateral local flaps were insufficient to cover a huge defect of the periorbital region. We performed 11 cadaver dissections to determine the type of vascularisation of the orbitonasolabial flap and to define its arc of rotation prior to contralateral use.

Post-ablative reconstruction of the medial canthus and medial orbital wall using conchal cartilage graft with three illustrative cases.

When the medial third of the upper or lower eyelid has to be reconstructed after full-thickness tumour excision, we usually use Hübner tarsomarginal grafts, but when medial canthal lesions spread to the medial orbital wall without invading the orbital margin, conchal graft becomes our first surgical option. Previously reported solutions to this difficult problem are few and concern more directly medial orbital wall fractures. We found no article dealing specifically with the use of conchal graft in post-ablative reconstruction of the medial orbital wall.

[A tailor-made flap for an extremely severe case of hidradenitis suppurativa in the genital area].

Hidradenitis suppurativa is a chronic, suppurative and scarring disease characterized by painful, inflamed lesions in the axillae, perineum, groin, scrotum and other parts of the body with apocrine-bearing skin including genital skin. Appropriate medical treatment alone appears to be insufficient for managing most patients with severe lesions. In the vast majority of cases, surgery consists in complete excision of the lesions with primary closure or healing by secondary intention.