Jean-Luc Nizet

Cellulite : From standing fat herniation to hypodermal stretch marks

There are glaring discrepancies in the microanatomical descriptions of cellulite in the literature. We revisited this common skin condition in women with a microscopic examination of 39 autopsy specimens. A control group consisted of 4 women and 11 men showing no evidence of cellulite. The lumpy aspect of the dermohypodermal interface appeared to represent a gender-linked characteristic of the thighs and buttocks without being a specific sign of cellulite. Incipient cellulite identified by the mattress phenomenon was related to the presence of focally enlarged fibrosclerotic strands partitioning the subcutis. Such strands possibly serve as a physiologic buttress against fat herniation limiting the outpouching of fat lobules on pinching the skin. These structures might represent a reactive process to sustained hypodermal pressure caused by fat accumulation. Full-blown cellulite likely represents subjugation of the hypertrophic response when connective tissue is overcome by progressive fat accumulation. Histologic aspects reminiscent of stretch marks are identified within the hypodermal strands, resulting in clinical skin dimpling.

Laddering melanotic pattern of Langer’s lines in skin of colour

Mechanobiological stimulation of the skin influences melanocyte activity. The clinical impact on melanocytes can be perceived by dermoscopy. Our aim was to assess the orientation of Langers lines using the combination of ultrasound shear wave propagation and dermoscopy in 70 adults of darker skin complexion. On the back, 44/70 patients showed a honeycomb melanotic pattern without any main orientation. By contrast, a streaky parallel pattern of melanotic lines oriented in the direction of Langers lines was found in 26/70 patients. Indeed, the maximum speed of ultrasound propagation was found parallel to the main orientation of the laddering melanotic pattern. The parallel melanotic pattern probably reflects the main orientation of the epidermal rete ridges aligned in the direction of Langers lines. This aspect could be ascribed to the deepening of these structures and/or to mechanobiology affecting melanocytes. The aspect is reminiscent of that previously described in striae distensae and atrophic scars.

Oncological and surgical outcome after oncoplastic breast surgery

Abstract Background : Oncoplastic surgery combines breast-conserving treatment and plastic surgery techniques. The aim of the study was to identify breast and tumor-related characteristics that contribute to the rate of complications and recurrence. Material & Methods : This retrospective study included 72 patients with a median follow-up of 32 months. For each patient, a comprehensive set of data was collected, including epidemiology, tumor characteristics, preoperative information, detailed pathology reports, radiotherapy treatment and type of surgical technique. The rate of complications, recurrence and survival were studied. Results : Complete tumor removal was performed with clear margins in all patients but in 25 of them margins were less than 2 mm. One patient had local recurrence and another developed distant metastases. The study showed that the size of the margin was not predictive of recurrence as long as not positive; the greater the resection volume, the larger the excision margin. The resection size was the only factor influencing complications and no specific tumor-related factor significantly increased the complication rate. Surgical complications did not delay the initiation of chemotherapy and radiotherapy. Conclusion : This is the first oncoplastic study where both tumor and breast characteristics were analyzed using the most recent criteria of the literature. Oncoplastic surgery can be considered as oncologically safe. The resection size was the sole significant risk factor for postoperative complications. Complications after oncoplastic breast surgery did not differ neoadjuvant therapy. Long-term event-free survival was excellent (96% at 7 years).

Toward targeted early burn care: lessons from a European survey.

During the year 2011, a survey was performed to describe current practices throughout Europe regarding three critical issues of acute burn care, namely fluid resuscitation, nutrition, and burn wound excision strategy. Thirty-eight questionnaires returned by burn centres from 17 different European countries were analyzed. The survey shows that Parkland remains the most commonly used formula to determine fluid needs in adults. All respondent centers use urine output to guide fluid resuscitation. While early excision of deep burns is the rule among centers, burn depth assessment by laser Doppler imaging is used in only a few centers. Indirect calorimetry and Toronto formula to estimate energy requirements do not have unanimous backing from respondents. Current literature encourages clinicians to move forward targeted and individualized therapies using a bundle of basic and advanced hemodynamic parameters, indirect calorimetry, and laser Doppler imaging. The results of this study suggest that such an approach is not common yet, and reinforce the subsequent need for large clinical trials that would evaluate the impact of such guided therapies to provide recommendations with a significant level of evidence.

Proprietes biomecaniques de la peau au cours de l'expansion tissulaire en reconstruction mammaire.

Mammary reconstruction following mastectomy involves breast augmentation, which probably sets the skin under tension. This aspect of mechanobiology has rarely been explored in an objective way. The aim of the present study was to measure the biomechanical properties of skin using a suction method. Eight sites of the thorax were assessed in 26 cases of mastectomy performed in 20 women aged 49+/-7 years. In order to distinguish the effects of breast augmentation from forces exerted by earth gravitation, measurements were performed in standing and lying down positions, both before and after breast augmentation of about 450 ml.

Revisiting biothermal effects on erythematous hypertrophic scars during pregnancy

Background  Pregnancy is possibly associated with altered wound healing including the development of hypertrophic or keloidal scarring. The management of these lesions may prove to be difficult, and there are no universally accepted treatment protocols.

Current Concepts in Breast Reconstruction

Abstract As the incidence of breast cancer increases, breast reconstruction is more and more often proposed and its indications are viewed in terms of quality of life. In the past, delayed reconstruction was the rule. Progress in reconstructive techniques currently allows performing immediate reconstruction in selected cases, even when the operative field has to be irradiated. These new techniques generally improve the result of breast reconstruction. Moreover, expansion of screening techniques allows detection of small tumors for which a conservative excision is sufficient. Nevertheless, this kind of less aggressive surgery may require a reconstructive procedure in order to maximise the aesthetic result.

Couverture de pertes de substance du tibia distal par lambeau pedicule perforant en helice : deux cas cliniques.

Distal lower leg soft tissue defect is frequently a challenge to repair, particularly on the tibial crest. The coverage of this kind of lesion has some limitations because of regional minimal blood supply and paucity of local soft-tissue flaps. The perforator pedicled propeller (PPP) method tries to find a new place in lower leg reconstruction in bringing similar tissues at the recipient site and avoiding long and difficult free flap transfer or muscular sacrifice. The authors report on the use of PPP method for a tibial crest exposure after trauma and for a soft tissue defect with osteomyelitis on the tibial crest.