Publications by authors named "Jean-Paul Meningaud"

114 Publications

An approach to a repeated self-biting tongue injury in a toddler.

Arch Pediatr 2021 Sep 8. Epub 2021 Sep 8.

Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps University, Marburg 35043, Germany.

Background: Children with tongue injuries often visit the pediatric emergency department. The vast majority of cases can be conservatively treated, while some injuries require operative repair. The aim of this article was to demonstrate a "back-to-basics" approach to a refractory bifid tongue injury in a toddler.

Case Description: A 1-year-old toddler with a tongue injury was unsuccessfully treated three times within a week by a surgeon in another specialty; all reconstructions were mucosal only. The case was then referred to our maxillofacial unit for proper management. On examination, the recurrent injury seemed to occur because of the patient's self-biting habit. We performed the fourth reconstruction of the tongue muscles and mucosa, and because of no dental prosthetic laboratory available in our hospital, we used transparent adhesive drapes fixed by resorbable sutures to cover the patient's anterior teeth instead of bite guards. The toddler was fed via a nasogastric tube for 1 week under 2-day antibiotic prophylaxis and routine oral care. The patient was discharged without any complications 1 week later.

Conclusions And Practical Implications: The causes of repeated orofacial injuries should be identified and require particular attention to establish a proper treatment. For intraoral injuries in pediatric patients, self-biting habits should not be overlooked. The application of materials in an operating theater can help the treating clinicians improve the treatment outcomes.
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http://dx.doi.org/10.1016/j.arcped.2021.08.006DOI Listing
September 2021

Anatomical subject validation of an instrumented hammer using machine learning for the classification of osteotomy fracture in rhinoplasty.

Med Eng Phys 2021 Sep 13;95:111-116. Epub 2021 Aug 13.

CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, 61 avenue du Général de Gaulle, Créteil 94010, France. Electronic address:

Osteotomies during rhinoplasty are usually based on the surgeon's proprioception to determine the number and the strength of the impacts. The aim of this study is to determine whether a hammer instrumented with a force sensor can be used to classify fractures and to determine the location of the osteotome tip. Two lateral osteotomies were realized in nine anatomical subjects using an instrumented hammer recording the evolution of the impact force. Two indicators τ and λ were derived from the signal, and video analysis was used to determine whether the osteotome tip was located in nasal or frontal bone as well as the condition of the bone tissue around the osteotome tip. A machine-learning algorithm was used to predict the condition of bone tissue after each impact. The algorithm was able to predict the condition of the bone after the impacts with an accuracy of 83%, 91%, and 93% when considering a tolerance of 0, 1, and 2 impacts, respectively. Moreover, in nasal bone, the values of τ and λ were significantly lower (p < 10) and higher (p < 10) than in frontal bone, respectively. This study paves the way for the development of the instrumented hammer as a decision support system.
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http://dx.doi.org/10.1016/j.medengphy.2021.08.004DOI Listing
September 2021

Validation of an Instrumented Hammer for Rhinoplasty Osteotomies: A Cadaveric Study.

Facial Plast Surg Aesthet Med 2021 Aug 27. Epub 2021 Aug 27.

Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Hôpital Henri Mondor, Créteil, France.

Osteotomies during rhinoplasty are usually based on surgeon's proprioception to determine the number, energy, and trajectory of impacts. The first objective was to detect the occurrence of fractures. The second objective was to determine when the thicker frontal bone was encountered by the osteotome. An instrumented hammer was used to measure the impact force during lateral osteotomies on nine human anatomic specimens. A prediction algorithm was developed using machine learning techniques, to detect the occurrence of fractures, and the proximity of the osteotome to the frontal bone. The algorithm was able to predict the occurrence of fractures and the proximity to the frontal bone with a prediction rate of 83%, 91%, and 93% when allowing for an error of 0, 1, and 2 impacts, respectively. The location of the osteotome in the frontal bone was predicted with an error of 7.7%. An osteotomy hammer measuring the impact force when performing lateral osteotomies can predict the occurrence of fractures and the proximity to the frontal bone, providing the surgeon with instant feedback.
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http://dx.doi.org/10.1089/fpsam.2021.0107DOI Listing
August 2021

Are oral lichen planus patients at high risk of hepatitis C? A case-control study.

J Stomatol Oral Maxillofac Surg 2021 Jul 28. Epub 2021 Jul 28.

Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.

Objective: To assess the correlation between oral lichen planus (OLP) and viral hepatitis C (HCV).

Methods: This retrospective case-control study included a sample of OLP patients in a 3-year interval. The predictor variable was the presence of OLP (yes/no). The outcome variable was the diagnosis of HCV. Other study variables were grouped into demographic, anatomic, and clinical. Descriptive, bi- and multivariate statistics were computed with a significant level at P ≤ 0.05.

Results: The sample was composed of 237 OLP patients (38.8% females) with a mean age of 59.9 ± 17.8 years (range, 17-96), and 948 age- and gender-matched control individuals. The significant higher frequency of HCV was identified in OLP patients (frequency: 19.8% vs. 2.1%; adjusted matched odds ratio [mOR], 9.5; 95% confidence interval [95% CI], 5.98 to 15.91; P < 0.0001; Pearson's Phi coefficient [r], 0.307). In the adjusted model, OLP with HCV was associated with 1) oro-cutaneous manifestations (mOR, 17.58; 95% CI, 1.92 to 161.26; P = 0.0059; Bayesian posterior probability of positive test [W], 96%), 2) any intraoral forms other than reticular/plaque-liked forms (mOR, 0.09; 95% CI, 0.04 to 0.18; P < 0.0001; W, 52%), and 3) poor response to topical corticosteroids (mOR, 0.05; 95% CI, 0.02 to 0.16; P < 0.0001; W, 88%).

Conclusions: OLP, especially oro-cutaneous disease or steroid-refractory OLP, are associated with an increased frequency of HCV. Not only HCV screening in OLP patients, but oral examination in HCV patients, are both recommended as primary preventive measures.
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http://dx.doi.org/10.1016/j.jormas.2021.07.013DOI Listing
July 2021

Hymen Restoration: An Experience From a Moroccan Center.

Aesthet Surg J 2021 Jul 12. Epub 2021 Jul 12.

Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France.

Background: Hymenoplasty is one of the least described vulvovaginal procedures in plastic surgery without any surgical standard that attempts to restore the hymen's ability to bleed during sexual intercourse on a couple's wedding night.

Objectives: The objective of this study is to report outcomes from a Moroccan retrospective study of a series of 529 patients who underwent either a hymenorrhaphy or a hymenoplasty.

Methods: This was a retrospective study of 529 patients who underwent hymen restoration at a center in Morocco between April 2010 and April 2019. The data were collected according to the requirements of the center through preoperative and postoperative consultations, presential or phone post-coital interviews. The procedure consisted of suturing the edges of the hymen remnants using Vicryl 5-0, leaving a small opening in the newly reconstructed hymen. Two techniques - Hymenal Flap Hymenoplasty (HLH) and Vaginal Flap Hymenoplasty (HLV) - are used depending on the presence or absence of hymen remnants.

Results: A total of 529 patients were underwent hymen restoration, including 42% hymenorrhaphies, 58% hymenoplasties, 39% HLH, and 19% HLV. The mean age of the patients was 32 years. Of the 227 women who underwent a hymenorrhaphy, no failure was reported, and all the patients who had sexual intercourse within 15 days of the procedure experienced vaginal bleeding. Of the 99 hymenoplasties using vaginal flaps, only one failure was reported.

Conclusions: The techniques used in our cohort are safer and the complications are minor with general satisfaction of patients.
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http://dx.doi.org/10.1093/asj/sjab276DOI Listing
July 2021

Striae Distensae: In Vitro Study and Assessment of a Combined Treatment with Sodium Ascorbate and Platelet Rich Plasma on Fibroblasts.

Aesthetic Plast Surg 2021 Jul 1. Epub 2021 Jul 1.

Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.

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http://dx.doi.org/10.1007/s00266-021-02445-7DOI Listing
July 2021

Invited Response on: Striae Distensae: In Vitro Study and Assessment of a Combined Treatment With Sodium Ascorbate and Platelet-Rich Plasma on Fibroblasts.

Aesthetic Plast Surg 2021 08 27;45(4):1963-1964. Epub 2021 May 27.

Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.

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http://dx.doi.org/10.1007/s00266-021-02262-yDOI Listing
August 2021

Augmented reality-assisted deep inferior epigastric artery perforator flap harvesting.

J Plast Reconstr Aesthet Surg 2021 08 22;74(8):1931-1971. Epub 2021 Apr 22.

Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France; Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France; INSERM Team U955-E10, Biology of the NeuroMuscular System, Paris East University, 94000 Créteil, France.

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http://dx.doi.org/10.1016/j.bjps.2021.03.122DOI Listing
August 2021

Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique.

J Sex Med 2021 05 27;18(5):996-1008. Epub 2021 Apr 27.

Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France.

Introduction: Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the female external genitalia or any other injury of the female genitalia that is performed for nonmedical reasons. FGM is classified into 4 types. Surgical clitoral reconstruction was first described by Thabet and Thabet in Egypt and subsequently by Foldès in France. The technique was then modified by different authors.

Aim: This article aims to provide a detailed description of clitoral surgical reconstruction and the modifications which have been made over time to improve the procedure while recalling current knowledge in the anatomy of the clitoris.

Methods: We performed a broad systematic search in PubMed/Medline and EMBASE bibliographic databases for studies that report the surgical technique of clitoral reconstruction. From the anatomical point of view, we examined available evidence (from 1950 until 2020) related to clitoral anatomy, the clitoral role in sexual functioning, female genital mutilation/cutting, and surgical implications for the clitoris.

Main Outcomes: A review of the surgical techniques for clitoral reconstruction after female genital mutilation/cutting RESULTS: We described the current anatomical knowledge about the clitoris, and the procedures based on the surgical technique by Pierre Foldès, We included the technical modifications and contributions described in articles published subsequently.

Conclusion: Surgical repair of the clitoris for FGM offers anatomical and functional results although they still have to be evaluated. However, it should not be the only therapeutic solution offered to women with FGM. Botter C, Sawan D, SidAhmed-Mezi M, et al. Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique. J Sex Med 2021;18:996-1008.
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http://dx.doi.org/10.1016/j.jsxm.2021.02.010DOI Listing
May 2021

Carboxytherapy, subcutaneous injections of carbon dioxide in the management of infraorbital dark circles: A reliable and effective procedure.

J Craniomaxillofac Surg 2021 Aug 5;49(8):670-674. Epub 2021 Feb 5.

Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue Du Maréchal de Lattre de Tassigny, 94000, Créteil, France.

The aim of this study is to assess the efficacy and tolerability of carboxytherapy in the cosmetic correction of dark circles. Carboxytherapy is a cosmetic technique based on the subcutaneous injection of carbon dioxide that improves the quality and elasticity of the dermis by increasing the oxygen release to the tissue through an enhancement of the Bohr effect. A prospective clinical trial was conducted on 35 patients requesting the correction of dark cicles. Our protocol was based on weekly treatment sessions and lasted 3 weeks. Each treatment session was based on the bilateral injections of the tear-through defect. Pre- ∖treatment photographs and 6-month post-procedural follow-up photographs were examined and analysed through a face objective assessment scale. All 35 patients were treated. The average scores showed a significant reduction of the skin discoloration without major side effects (p < 0.00001). This study proves that it is possible to carry out multiple injections during the same session to increase the application time of the carbon dioxide and to decrease the number of sessions. These results allowed us to validate a 3-sessions injection protocol to increase the patient compliance.
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http://dx.doi.org/10.1016/j.jcms.2021.01.028DOI Listing
August 2021

Synergistic Effects of Autologous Platelet-Rich Plasma and Hyaluronic Acid Injections on Facial Skin Rejuvenation.

Aesthet Surg J 2021 06;41(7):NP854-NP865

Department of Plastic and Cosmetic Reconstructive Surgery, Henri Mondor Hospital, Créteil, France.

Background: Many therapeutic options are currently available for facial skin rejuvenation, but little evidence exists about the efficacy of combining such procedures.

Objectives: The aim of this study was to assess and investigate the synergistic effect of hyaluronic acid (HA) and autologous platelet-rich plasma (a-PRP) injections on facial skin rejuvenation.

Methods: For this randomized controlled prospective study, 93 eligible patients were enrolled and randomized into 3 intervention groups to undergo a series of 3 treatment sessions with either a-PRP, HA, or a mixture of a-PRP and HA (Cellular Matrix; Regen Lab) injected into facial cheeks.

Results: A total of 93 patients were included. Treatment with Cellular Matrix led to a very significant improvement in the overall facial appearance compared with treatment with a-PRP or HA alone (P < 0.0001). Participants treated with Cellular Matrix showed a 20%, 24%, and 17% increase in FACE-Q score at 1, 3, and 6 months posttreatment, respectively. For the HA group, the improvement in FACE-Q score was 12%, 11%, and 6% at 1, 3, and 6 months posttreatment, respectively, whereas for the a-PRP group the improvement was 9%, 11%, and 8% at 1, 3, and 6 months posttreatment, respectively. Biophysical measurements showed significantly improved skin elasticity for the Cellular Matrix group compared with the groups receiving a-PRP or HA alone. No serious adverse events were reported.

Conclusions: Combining a-PRP and HA seems to be a promising treatment for facial rejuvenation with a highly significant improvement in facial appearance and skin elasticity compared with a-PRP or HA alone.

Level Of Evidence: 3:
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http://dx.doi.org/10.1093/asj/sjab061DOI Listing
June 2021

A German AWMF's S2e/realist synthesis and meta-narrative snapshot of craniomaxillofacial manifestations in COVID-19 patients: Rapid living update on 1 January 2021.

J Stomatol Oral Maxillofac Surg 2021 Jan 30. Epub 2021 Jan 30.

Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.

Purposes: To execute a review answering the following question: "Among novel coronavirus disease (COVID19) patients, what are craniomaxillofacial (CMF) manifestations?" based on the RAMESES and the German Association of Scientific Medical Societies (AWMF)'s S2e guidelines.

Methods: We performed a realist synthesis and meta-narrative review extracting data in English, French, German and Thai from PubMed/Medline, Embase, Biomed Central, Cochrane Library, and Thai Journals Online, until 1 January 2021. The primary outcome variable was CMF manifestations grouped into 5 categories: (1) mouth and throat, (2) nose, paranasal sinus, and skull base (3) ocular/orbital and periorbital tissue, (4) ear, and (5) craniofacial skin. Appropriate statistics was computed.

Results: Thirty-seven original articles meeting the inclusion criteria were analysed; all were in English and indexed in PubMed/Medline. Hand searches of their references yielded a total of 101 articles for the review. Most data were in low level of evidence and focused on smell and taste disturbances and non-specific orofacial lesions. Iatrogenic complications may occur in this body region. Conservative measures remained effective and were usually enough for patient care.

Conclusion: Because SARS-CoV-2 infection is new and becomes the stringent worldwide pandemic within a short time period, most of the data on CMF symptoms are of low level evidence. Apart from taste and smell dysfunctions, non-specific CMF lesions can be found and treated conservatively. Treatment complications are possible. Dentists and CMF surgeons are privileged to examine the orofacial region and work closely with colleagues in other specialities to combat this pandemic.
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http://dx.doi.org/10.1016/j.jormas.2021.01.012DOI Listing
January 2021

Factors associated with epiphora following orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty.

J Surg Oncol 2021 Apr 1;123(5):1246-1252. Epub 2021 Feb 1.

Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, Campus Marburg, UKGM GmbH, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.

Purpose: The aims of the study were to estimate the frequency of epiphora and to identify factors associated with epiphora after orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty (OSOSM-MWFILB).

Methods: We performed a retrospective cohort study enrolling a sample derived from the patient population undergoing OSM-MWFILB over a 7-year period. The predictor variables were grouped into demographic, related health status, anatomic, tumor-specific, and therapeutic categories. The primary outcome variable was the presence of postmaxillectomy epiphora (PME). Descriptive, univariate, and multivariate regression mixed-effect models were computed.

Results: The study sample was composed of 134 patients (46.3% females; 71.6% squamous cell carcinomas) with a mean age of 64.7 ± 12.2 years. There were 23 (17.2%) PME events, which were significantly associated with eight variables: male gender, poor general health (ASA III-IV), large vertical defect (Brown and Shaw's class III-IV), squamous cell carcinoma tumor type, big tumor size (T3-4), cervical lymph node metastasis (N1-2), long operating time > 3 h, and adjuvant radio(chemo)therapy in both univariate mixed regression and multivariate Cox hazards analyses. Healing of PME in irradiated patients was significantly delayed.

Conclusions: Ophthalmologic consequences in patients undergoing OSM-MWFILB require particular attention, especially in case of advanced tumors, multiple comorbidities, or long surgery with postoperative radio(chemo)therapy. This emphasizes the importance of appropriate cooperation between the surgeons and ophthalmic colleagues.
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http://dx.doi.org/10.1002/jso.26408DOI Listing
April 2021

Striae Distensae: In Vitro Study and Assessment of Combined Treatment With Sodium Ascorbate and Platelet-Rich Plasma on Fibroblasts.

Aesthetic Plast Surg 2021 06 20;45(3):1282-1293. Epub 2021 Jan 20.

Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.

Introduction: Striae distensae (SD) appear clinically as parallel striae, lying perpendicular to the tension lines of the skin. SD evolve into two clinical phases, an initial inflammatory phase in which they are called "striae rubrae" (SR) and a chronic phase in which they are called striae albae (SA). Fibroblasts seem to play a key role in the pathogenesis of stretch marks. This study was aimed at describing and analyzing stretch marks-derived fibroblasts (SMF), the differences between SR- and SA-derived fibroblasts (SRF, SAF), testing two treatments in vitro (sodium ascorbate and PrP) on SAF.

Material And Methods: To characterize the SMF, the expression of alpha smooth muscle actin (alpha SMA) was investigated. Type I collagen expression was measured in SAF, before and after adding different PrP concentrations and sodium ascorbate in the culture medium. Results were processed through statistical analysis models using the Student's t-test.

Results: A significant increase in alpha SMA (P <0.001) was observed in SRF. SAF treated with PrP and sodium ascorbate showed a resumption of their metabolic activity by an increase in collagen type I production and cell proliferation. After 24 h of incubation with PrP 1% and PrP 5% + sodium ascorbate, cell viability was increased by 140% and 151% and by 156 and 178% after 48 h, respectively, compared to the control.

Conclusion: Our study shows that a biologically mediated improvement in SMF metabolic activity is possible. Our promising results require further trials to be able to confirm the reproducibility of this combined treatment, particularly in vivo.

No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable.
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http://dx.doi.org/10.1007/s00266-020-02100-7DOI Listing
June 2021

Face transplantation: A longitudinal histological study focusing on chronic active and mucosal rejection in a series with long-term follow-up.

Am J Transplant 2021 09 15;21(9):3088-3100. Epub 2021 Feb 15.

APHP (Assistance Publique-Hôpitaux de Paris), Pathology Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Créteil, France.

The 2007 Banff working classification of skin-containing Tissue Allograft Pathology addressed only acute T cell-mediated rejection in skin. We report the longitudinal long-term histological follow-up of six face transplant recipients, focusing on chronic and mucosal rejection. We identified three patterns suggestive of chronic rejection (lichen planus-like, vitiligo-like and scleroderma-like). Four patients presented lichen planus-like and vitiligo-like chronic rejection at 52 ± 17 months posttransplant with severe concomitant acute T cell-mediated rejection. After lichen planus-like rejection, two patients developed scleroderma-like alterations. Graft vasculopathy with C4d deposits and de novo DSA led to subsequent graft loss in one patient. Chronic active rejection was frequent and similar patterns were noted in mucosae. Concordance between 124 paired skin and mucosal biopsies acute rejection grades was low (κ = 0.2, p = .005) but most grade 0/I mucosal rejections were associated with grade 0/I skin rejections. We defined discordant (grade≥II mucosal rejection and grade 0/I skin rejection) (n = 55 [70%]) and concordant (grade≥II rejection in both biopsies) groups. Mucosal biopsies of the discordant group displayed lower intra-epithelial GranzymeB/FoxP3 ratios suggesting a less aggressive phenotype (p = .08). The grading system for acute rejection in mucosa may require phenotyping. Whether discordant infiltrates reflect a latent allo-immune reaction leading to chronic rejection remains an open question.
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http://dx.doi.org/10.1111/ajt.16489DOI Listing
September 2021

Bacteriological and mechanical impact of the Sterrad sterilization method on personalized 3D printed guides for mandibular reconstruction.

Sci Rep 2021 01 12;11(1):581. Epub 2021 Jan 12.

Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

Surgical cutting guides are increasingly used for maxillofacial reconstruction. They are usually provided by laboratories. In recent years, surgical teams have published studies on the possibility of manufacturing their own cutting guides thanks to 3D printers. The object of this study is to analyze the impact of the sterilization on the surface of those personalized models and to assess the effectiveness of sterilization. Using the data from high-resolution CT scan of patient, 3D models were generated through computerized assisted design and fabricated with a 3D printer using Acrylonitrile Butadiene Styrene (ABS). For the sterilization, a Sterrad method was used. In order to evaluate the effectiveness of sterilization, 3D models were artificially contaminated with several bacterial reference strains, sterilized and finally cultured. The surfaces and mechanical modifications were analyzed before and after sterilization with infrared spectrometry, surface contact angle, extensometer, scanning electron microscopy and atomic force microscopy. Ten models of different shapes and 24 samples were fabricated, sterilized and analyzed. The 3D models were designed in 48 h, printed in an average of 122 min and underwent a 47 min cycle of sterilization. All experimentally contaminated 3D models were negative in culture, with at least, a six log reduction of the initial inoculum. The hydrophobicity and roughness of the surface suffered few changes. The reproducibility of this procedure was proved by identical results in the three sterilization rounds. Using Sterrad process for the sterilization of ABS printed material doesn't represent a bacterial risk for the patient. It is a feasible and safe innovative reconstructive method that can save time particularly for oncological cases.
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http://dx.doi.org/10.1038/s41598-020-79752-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804113PMC
January 2021

Surgical treatment of clitoral phimosis.

J Gynecol Obstet Hum Reprod 2021 Jun 21;50(6):101919. Epub 2020 Sep 21.

Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France. Electronic address:

The clitoris has a crucial role in the feminine pleasure. Chronic inflammatory dermatosis along with post-menopausal atrophy of the vulva and obstetrical traumas can cause clitoral phimosis, thereby compromising its function. Medical treatments exist depending on the etiology, but when irreversible scarring occur, a surgical treatment can be necessary to regain its function. We present here our surgical technique that achieves excellent functional results with low morbidity and the outcome of our patients in order to improve this sexual dysfunction.
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http://dx.doi.org/10.1016/j.jogoh.2020.101919DOI Listing
June 2021

Yoga Breathing Exercises (Pranayama) Decrease Hand Microtremor in Young Microsurgeons: Toward a New Paradigm in Surgery.

Plast Reconstr Surg 2020 11;146(5):701e-703e

Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII, Créteil, France.

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http://dx.doi.org/10.1097/PRS.0000000000007307DOI Listing
November 2020

Microfat and Nanofat Grafting in Genital Rejuvenation.

Aesthet Surg J 2021 08;41(9):1060-1067

Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, Créteil, France.

Background: Genitourinary syndrome of menopause (GSM) is a major problem in many post- or perimenopausal women. Lipofilling has long been considered to be an effective technique for restoring volume, but the discovery of its trophic proprieties has made it the most widely utilized method in regenerative medicine.

Objectives: The authors aimed to assess the safety and efficacy of microfat and nanofat grafting for vulvovaginal rejuvenation.

Methods: Women with GSM who met the inclusion criteria were enrolled. Women received microfat in the labia majora and nanofat in the vagina; follow-up was conducted 1, 3, 6, 12, and 18 months. The vaginal health index (VHI) and Female Sexual Distress (FSD) were utilized to assess improvement in vulvovaginal atrophy, orgasm, and sexual desire posttreatment.

Results: Fifty women were included; their average age was 53 years (range, 45-63 years). The VHI score significantly increased at 1 and 3 months after treatment (P < 0.0001). Moreover, the average FSD score showed a significant improvement at 1 and 3 months posttreatment. This score stabilized from 6 to 12 months but showed further improvement at 18 months. At 6 months posttreatment, for both scales, data pertaining to 80% of patients appeared normalized. There was a particular benefit noted for dryness and dyspareunia. At 18 months, the results remained stable for all of patients. No major side effects were observed.

Conclusions: There are now many ways to rejuvenate the intimate sphere, but microfat and nanofat grafting seem to offer good results with an autologous procedure. Their utilization appears promising for genital rejuvenation.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjaa118DOI Listing
August 2021

Postoperative Complications and Patient Satisfaction After Abdominal Etching: Prospective Case Series of 25 Patients.

Aesthetic Plast Surg 2020 06 16;44(3):830-835. Epub 2019 Dec 16.

Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

Introduction: Conventional liposuction has provided good outcome for years. Abdominal etching (or abdominal high definition liposuction) allows the surgeon to shape and enhance the abdominal muscles by removing specific grooves of subcutaneous fat. The aim of this study is to describe the technique and the complications and to assess patients' satisfaction rate.

Materials And Methods: Between January 2015 and January 2017, 25 patients (21 men and 4 women) underwent abdominal etching procedures in our department. The authors describe the technique and the specific key points of the procedure. All patients were seen at day 5, 10, 30, and 180. At day 180, everyone answered a modified Likert scale survey relating to their satisfaction.

Results: No hematoma, infection, or seroma was reported. One patient experienced a superficial pressure wound caused by an improper positioning of the final dressing. Almost all patients (96%) were happy or very happy with the overall outcome of their abdominal etching.

Conclusion: The number of requests for abdominal liposculpture should increase in the coming years, and plastic surgeons specialized in silhouette surgery should be able to master this technique in order to add it to their therapeutic arsenal.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-019-01558-4DOI Listing
June 2020

Platelet-Rich Plasma Improves the Wound Healing Potential of Mesenchymal Stem Cells through Paracrine and Metabolism Alterations.

Stem Cells Int 2019 31;2019:1234263. Epub 2019 Oct 31.

Université Paris-Est, UMR-S955, UPEC, Créteil, France.

Chronic and acute nonhealing wounds represent a major public health problem, and replacement of cutaneous lesions by the newly regenerated skin is challenging. Mesenchymal stem cells (MSC) and platelet-rich plasma (PRP) were separately tested in the attempt to regenerate the lost skin. However, these treatments often remained inefficient to achieve complete wound healing. Additional studies suggested that PRP could be used in combination with MSC to improve the cell therapy efficacy for tissue repair. However, systematic studies related to the effects of PRP on MSC properties and their ability to rebuild skin barrier are lacking. We evaluated in a mouse exhibiting 4 full-thickness wounds, the skin repair ability of a treatment combining human adipose-derived MSC and human PRP by comparison to treatment with saline solution, PRP alone, or MSC alone. Wound healing in these animals was measured at day 3, day 7, and day 10. In addition, we examined in vitro and in vivo whether PRP alters in MSC their proangiogenic properties, their survival, and their proliferation. We showed that PRP improved the efficacy of engrafted MSC to replace lost skin in mice by accelerating the wound healing processes and ameliorating the elasticity of the newly regenerated skin. In addition, we found that PRP treatment stimulated , in a dose-dependent manner, the proangiogenic potential of MSC through enhanced secretion of soluble factors like VEGF and SDF-1. Moreover, PRP treatment ameliorated the survival and activated the proliferation of cultured MSC and that these effects were accompanied by an alteration of the MSC energetic metabolism including oxygen consumption rate and mitochondrial ATP production. Similar observations were found following combined administration of PRP and MSC into mouse wounds. In conclusion, our study strengthens that the use of PRP in combination with MSC might be a safe alternative to aid wound healing.
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http://dx.doi.org/10.1155/2019/1234263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875194PMC
October 2019

Oncological and aesthetic outcome following surgical management of orbito-palpebral skin cancers: A retrospective study of 132 patients.

J Craniomaxillofac Surg 2019 Oct 16;47(10):1577-1582. Epub 2019 Jul 16.

Department of Plastic, Reconstructive and Maxillo-Facial Surgery, Henri-Mondor Hospital, AP-HP, Creteil, France.

Background: The incidence of facial skin cancers continues to rise, with major studies on their impacts still lacking in the literature. This study reports on the oncological and aesthetic results following surgical management of an orbito-palpebral skin cancer.

Methods: This retrospective, monocentric study included patients treated for a non-melanoma skin cancer of the eyelid and orbit. Risk factors, location, histological type, invaded or insufficient margins, healing time, surgical management by excision and direct closure, skin graft or local flaps, self-evaluated aesthetics, and quality of life results were all compared.

Results: The study included 132 patients operated for basal cell carcinoma (71.9%), squamous cell carcinoma (22.9%), or for another type (5.2%) between November 2011 and January 2017. Average tumor size was 9.6 ± 6.3 mm. Surgical management resulted in excision and open healing (9.1%), excision and direct closure (3.9%), skin graft (31.1%), local flap (21.9%), or another type of reconstruction (3.0%). Significant links between invaded or insufficient margins and basal cell type (OR = 3.37, p = 0.014), tumor size over 7 mm (OR = 2.7, p = 0.011), double location (OR = 8.44, p = 0.04), flap-based reconstruction (OR = 0.290, p = 0.02), and female gender (OR = 0.418, p = 0.034) were reported throughout our multivariate analysis.

Conclusions: This study brings out consequential information on factors linked with invaded or insufficient excision margins. Larger cohorts should evaluate the aesthetic outcomes in such a population.
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http://dx.doi.org/10.1016/j.jcms.2019.07.015DOI Listing
October 2019

One-step facial feminization surgery: The importance of a custom-made preoperative planning and patient satisfaction assessment.

J Plast Reconstr Aesthet Surg 2019 Oct 26;72(10):1694-1699. Epub 2019 Jun 26.

Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.

Background: The availability of more accurate techniques used for transgender surgery has resulted in an increased number of patients requesting facial feminization surgery (FFS). The aim of this study was to present the FFS pre-operative planning of the authors' male-to-female transsexual patients using photo-editing software, computer-aided design (CAD), modeling, and three-dimensional (3D) printing.

Material And Methods: Twenty-five patients underwent FFS between November 2015 and May 2018. They were retrospectively included in this study, and their records were analyzed. Patients' 3D facial models were printed and used for an accurate preoperative planning and shown to the patients. To assess patient satisfaction, the preoperative, six-month, and one-year postoperative scores obtained using Satisfaction With Life Scale (SWLS) and Subjective Happiness Scale (SHS) were compared. The scores following a normal distribution obtained for each patient were compared using a paired t-test.

Results: The 3D model preparation mean time was 145±13.2 min. A total of 114 surgical procedures were carried out. The mean operative time was 420±23 min. Patients experienced no postoperative complication. All patients were very satisfied after surgery, with a significant difference between pre- and postoperative scores (p = 0.002; p = 0.03).

Conclusion: With use of 3D modeling, surgeons are nearing a custom-made surgery era, especially required for complex procedures such as FFS. We suggest using 3D technology for a more accurate preoperative planning.
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http://dx.doi.org/10.1016/j.bjps.2019.06.014DOI Listing
October 2019

Proposal of a Noninvasive Method to Reduce Injection-Related Bruising in Aesthetic Medicine: Transillumination.

Aesthetic Plast Surg 2020 04 30;44(2):530-534. Epub 2019 Jul 30.

Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

Background: Hyaluronic acid (HA) injections involve a risk of vascular complications. Transillumination (TL) is a noninvasive technique that appears to allow preliminary detection of superficial vascular structures of the face to avoid intravascular HA injection. The purpose of our study was to test the efficacy of TL in terms of its sensitivity to locate vessels in the areas undergoing treatment and to reduce post-injection vascular complications.

Material And Methods: We conducted a prospective study enrolling 72 patients who consulted for HA injections to treat facial wrinkles. We used TL on one side of the face to obtain a vascular mapping of the face. The area undergoing testing was randomized for the TL technique. The primary study endpoint was sensitivity for identifying subcutaneous veins and the differences in complication rates between the side of the face where TL was used to guide the injection and the side of the face where no vascular exploration method was used.

Results: TL sensitivity for locating the superficial temporal vein was 100%, 91% for the supratrochlear, supraorbital and infraorbital veins, and 95% for the dorsal nasal veins (p < 0.01). The complication rate was higher on the side of the face where no vascular exploration method was used (22.2% vs 2.7%; p = 0.010046).

Conclusions: Our preliminary findings validate our hypothesis concerning the advantage of using TL to identify superficial veins before performing injections. This method is simple and affordable, and the learning curve is small.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-019-01447-wDOI Listing
April 2020

In search of a universal and objective method to assess facial aging: The new face objective photo-numerical assessment scale.

J Craniomaxillofac Surg 2019 Aug 16;47(8):1209-1215. Epub 2019 Mar 16.

Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.

Most patients who undergo cosmetic rejuvenation treatment hope to appear younger and healthier. Although a number of scales have been put forward to assess facial aging, to date none has focused on predicting patients' age. The purpose of our study was to validate a more complete version of the face - Objective assessment scale previously developed by the authors. Since patients with a photo-damaged skin can look older than others we created a new sub-scale: the facial photo-aging scale, in order to provide a more comprehensive method for the overall assessment of facial aging. The Rasch model was used as part of the validation process. We assigned a score to each patient based on the scales we have developed. The correlation between a patient's actual age and the obtained scores was analyzed; we also analyzed the inter-rater reliability and test-retest reliability. All the scales exceeded criteria for acceptability, reliability and validity. The facial aging scale we have developed may prove to be a valuable tool to assess patients before and after facial rejuvenation treatment or surgery, as well as for clinical research in the field of facial skin regeneration.
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http://dx.doi.org/10.1016/j.jcms.2019.03.014DOI Listing
August 2019

The Outcomes Assessment of the Plasma Blade Technology in Upper Blepharoplasties: A Prospective Study on a Series of 25 Patients.

Aesthetic Plast Surg 2019 08 29;43(4):948-955. Epub 2019 Mar 29.

Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

Background: The Dermo Ablation Surgery (DAS) Medical® (Technolux, Italy) device is a plasma blade which induces a plasma voltaic arc causing a retraction in the epidermis and superficial dermis.

Objective: The aim of our study is to prove the efficacy and safety of the DAS Medical® device in dermatochalasis size reduction.

Methods: Our prospective study included 25 adult patients presenting with upper eyelid dermatochalasis undergoing a two-session treatment protocol with the DAS Medical® device (with a month treatment-free interval). The primary end point was the reduction in the size of the dermatochalasis. The secondary end points were patient satisfaction, and a blinded assessment of the outcomes was carried out by 15 plastic surgery specialists on post-procedural pictures.

Results: The mean reduction in the size of the dermatochalasis was estimated at 2.47 mm on a 6-month follow-up (13.5 mm at T0 vs. 11.03 mm at 6 months, p = 0.0002) and 1.97 mm on a 12-month follow-up ((13.5 mm at T0 vs. 11.53 mm at 12 months, p = 0.0055). Eighty per cent of the patients and 78% of the assessing clinicians were globally satisfied with the results on a 12-month follow-up. The mean visual analogue pain score reported during the treatment was 4.5/10; MEOPA® was used in 23% of cases. No irreversible post-procedural sequelae (complications) were observed.

Conclusion: Voltaic plasma arc treatment with DAS Medical® is an effective technique for non-invasive blepharoplasty on moderate dermatochalasis patients not suffering from palpebral lipoptosis and is very well tolerated. It can be usefully and successfully associated with surgery.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-019-01360-2DOI Listing
August 2019

High-Intensity Focused Ultrasound: A Satisfactory Noninvasive Procedure for Neck Rejuvenation.

Aesthet Surg J 2019 07;39(8):NP343-NP351

Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France.

Background: High-intensity focused ultrasound (HIFU) is an advanced technology that has been developed in response to the growing demand for noninvasive face rejuvenation.

Objectives: The aim of this study was to evaluate the rejuvenation effects, patient satisfaction, and safety of HIFU treatment of the neck in a European population.

Methods: This was a prospective study of 20 patients. The patients were treated with HIFU, and the outcomes were investigated. The modified FACE-Objective Assessment Scale, developed by our team, and the subjective Investigator Global Improvement Assessment Scale (IGIAS; -1 to 3) were used to judge the results of HIFU. Five blinded evaluators scored the procedure outcomes based on photographs taken before and 6 months after the procedure. Side effects were reported and pain was evaluated on a visual analog scale of 0 to 10.

Results: Clinical results, such as better definition of the cervicomental angle, were observed in the treated areas. The pretreatment and posttreatment evaluation scores for double chin and skin laxity were evaluated by 4 of 5 evaluators as significantly improved. The IGIAS score was between 1 and 5 in 2 patients, between 6 and 10 in 7 patients, and between 11 and 15 in 11 patients. No patients had a score between -5 and 0. No major complications were reported. The mean pain scores for the D4, M7, and S7 transducer treatments were 5.6 (range, 4.5-6.7), 4.2 (range, 2.5-5.9), and 2.05 (range, 1.05-3.05), respectively.

Conclusions: HIFU may be considered a satisfactory, simple, reproducible, rapid, and safe procedure for neck rejuvenation.

Level of Evidence: 4.
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http://dx.doi.org/10.1093/asj/sjz093DOI Listing
July 2019

Improving Abdominal Plastic Scars with a Dietary Supplement-A Comparative Study.

Plast Reconstr Surg Glob Open 2018 Oct 4;6(10):e1907. Epub 2018 Oct 4.

Service of Plastic, Reconstructive and Aesthetic Surgery, and Maxillo-facial Surgery, Henri Mondor's Hospital, Créteil Cedex.

Introduction: Massive weight loss following bariatric surgery has a major functional and aesthetic impact on patients. Many patients are nonetheless reluctant to undergo plastic surgery in connection with their former obesity because they fear potentially large scars, even though such scars are not visible (ie, they are covered by undergarments).

Purpose: The aim of this study was to evaluate the quality of wound healing in patients receiving Celergen supplementation following abdominoplasty, compared with a control group. The hypothesis was that supplementation would speed up wound healing and improve scar quality.

Materials And Methods: We conducted a prospective, monocentric, controlled study of patients undergoing abdominoplasty. A group of patients received Celergen, a food supplement, for 3 months and were monitored for 1 year after their surgery.

Results: Of 33 patients who underwent abdominoplasty, 25 received Celergen supplements. There was no significant difference between the 2 groups. The mean time to wound healing was significantly better in the group receiving supplementation compared with the control group [respectively, 24.6 ± 9.31 days and 34 ± 13.48 days ( = 0.03)]. The Patient and Observer Scar Assessment Scale (POSAS) observer score was significantly better at 1 year in the group receiving supplementation compared with the control group [12.68 ± 6.6 and 17.38 ± 5.24 ( = 0.01), respectively]. There was no significant difference in the total POSAS score at 1 year ( = 0.166).

Conclusion: Celergen supplementation significantly improved the time to healing and the POSAS observer score at 1 year for patients undergoing abdominoplasty.
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http://dx.doi.org/10.1097/GOX.0000000000001907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250487PMC
October 2018

Fast and inexpensive production of "homemade" PRP: A simple method.

J Plast Reconstr Aesthet Surg 2019 02 13;72(2):356-362. Epub 2018 Nov 13.

Department of Plastic & Reconstructive Surgery and Maxillo-Facial Surgery, Henri Mondor Hospital 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.

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http://dx.doi.org/10.1016/j.bjps.2018.10.027DOI Listing
February 2019

Clinical benefit of using a multifractional Er:YAG laser combined with a spatially modulated ablative (SMA) module for the treatment of striae distensae: A prospective pilot study in 20 patients.

Lasers Surg Med 2019 03 27;51(3):230-238. Epub 2018 Nov 27.

Department of Plastic, Reconstructive and Maxillo facial Surgery, Hopital Henri Mondor, Creteil, 94010, France.

Background And Objective: Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non-invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD.

Study Design/materials And Methods: This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm , frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 μm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported.

Results: Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported.

Conclusion: Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. 51:230-238, 2019. © 2018 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/lsm.23042DOI Listing
March 2019
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