Impact of surgical first excision delay on function for heat-press hand injury by the Quick-DASH questionnaire: Series over 20 years.

BACKGROUND: Heat-press hand burn leads to complex and severe lesions, with potentiation of thermal burn by the crushing mechanism. Management remains poorly codified, and the surgical strategies found in the literature remain contradictory. The objective of our study is to report our experience and define the first burn excision delay through functional evaluation with a Quick-DASH questionnaire. METHODS: We carried out a retrospective study of 20 burned hands by heat-press managed in our burn unit between 2002 and 2021. Following data were collected, at least one year after the accident: Quick-DASH score, which was our primary endpoint, injury assessment according to the Tajima's classification, overall surgical management, and impact on their professional activity. A descriptive statistical analysis of these data was performed followed by a univariate analysis to assess the correlation between delay to first surgical excision and the long-term functional result (Quick-DASH score and time before return to work). RESULTS: Burns were Tajima grade 1 (supra-fascial dermal burn) in 35 % of cases, grade 2 (exposure of subfascial structures) in 45 % and grade 3 (bone or joint exposure) in 20 %. There were no cases of bone fractures. We received 18 out of 20 questionnaires with no significant differences between those who send back or not. The median QuickDash score was 7.15 [IQR 0-52.25]. The first surgical excision was performed with a median of 8 days after the accident [min: 0; max: 20]. The median time before return to work was 24 weeks [IQR 17-42.25]. Only 11 patients (55 %) were able to go on the initial employment. Spearman test found a strong trend for a negative correlation between the time to the first excision and the QuickDash score (ρ = -0.46; r2 = 0.087; p = 0.053). CONCLUSION: According to observations made in our unit and in agreement with Tajima, who first described heat-press injury, the first surgical excision should be performed approximately one week after the accident. Subsequent excisions may be performed to reassess the lesions and complete the debridement, with reconstruction to follow. Multidisciplinary management is still necessary, including early and intensive physiotherapy, psychological support, and assessment by an occupational physician.

["Junior Doctor" in Plastic Surgery, a new status. Evaluation of the practices after one semester of application of the reform]. / Docteur Junior en chirurgie plastique, un nouveau statut. Évaluation des pratiques après un semestre d'application de la réforme.

INTRODUCTION: The reform of the third cycle of medical studies in 2017 led to the creation of the status of "Junior Doctor", corresponding to the consolidation phase and allowing increasing autonomy and supervision from the intern. In plastic surgery, this status appeared for the first time in November 2021 in French hospitals; it lasts two years and succeeds the first four years of internship. MATERIAL AND METHODS: We sent a self-questionnaire by email in May 2022 to the 21 French Junior Doctors. This was interested in their training ground, formation program, consultation activity, operating program, integration into the on-call list, the existence of half-days of availability, and their general opinion on this reform and its implementation. RESULTS: We collected 20 questionnaires with a sex ratio of twelve men for eight women. The majority of respondents worked in a university hospital (85 %). 45 % had their consultations, 60 % had their own operating sessions under general anesthesia, and 35 % under local anesthesia. Only 25 % of them considered this reform to be a step forward in terms of training. CONCLUSION: The introduction of the status of Junior Doctor is contrasted within the various hospitals. Despite the progressive and supervised autonomy provided by this reform, it is generally perceived neutrally or negatively by Junior Doctors. The establishment of own consultations and operating sessions stands out as a key positive element allowing better application of the reform.

Catastrophes Liées À Une Explosion De Camionciterne Entre 2000 Et 2020. Deux Groupes Distincts.

Incidents involving tanker trucks regularly appear in the media. The one in Morogoro (Tanzania) on August 10th 2019 (killing at least 89) attracted our attention. We reviewed medical literature (sparse) and media reports to identify and analyse these incidents. In high income countries isolated accidents may be responsible for a few deaths. In low income countries "double" accidents can occur. A commonplace incident occurs which frequently has no victim. When the incident involves a petrol leak, people gather to scoop up the fuel. A spark ignites the petrol and the ensuing engulfing fire is in itself deadly. Frequently, it triggers a tanker BLEVE, which is responsible for a disaster. Preventing these casualties should include avoiding the initial incident, and also (and above all) discouraging the locals from scooping up fuel they can use or possibly sell in order to survive.

Congenital lamellar ichthyosis complicated with erosive pseudo pustulosis: A rare clincal entity. About a case and review of the literature.

INTRODUCTION: Lamellar ichthyosis is a rare congenital disorder that can be encountered by plastic surgeon in a daily practice. Its clinical diagnosis makes it an significant pathology to identify and to know how to treat. MATERIAL AND METHODS: We report the case of a patient suffering from lamellar ichthyosis complicated by erosive pseudo pustulosis of the scalp. Our treatment protocol with two intra-lesional delayed-corticoids (Kenacort ®) injections three months apart showed significant clinical improvement of the lesions. DISCUSSION: Congenital lamellar ichthyosis regroups various clinical presentations. Most of the therapeutic strategies described in the literature involve local and systemic treatments, weighing on patients and leading to modest results. Surgical treatment or hyaluronic injections have also been reported but they raise problematics regarding morbidity and efficiency. CONCLUSION: Our therapeutic strategy by two Kenacort ® injections three months apart is simple, reproductible and has shown efficiency in the treatment of our patient suffering from congenital lamellar ichthyosis complicated with erosive pseudo pustulosis of the scalp.

Impact of the 2020 French lockdown due to the SARS-CoV-2 pandemic on emergency consultations for pediatric burns in a regional referral hospital.

INTRODUCTION: SARS-CoV-2 pandemic required the establishment of total lockdown in France from March 17 to May 11, 2020. We analyzed the impact of this lockdown on the pediatric burn population consulting in our burn unit during this period compared to data from previous years in order to analyze our model of emergency care for children burned during this unprecedented situation. MATERIAL AND METHODS: We carried out a retrospective single-center study by reviewing files concerning emergency consultations for children burns during the total lockdown in France in 2020 (COVID group) compared to the same weeks of 2018 and 2019 (no-COVID group). RESULTS: We find a significant decrease in the number of consultations (P=0.02) during the confinement period. In the "COVID" group, we found a significant increase in burn to the hand (P=0.03) and lower limbs (P=0.03). The other criteria evaluated did not find any difference between the groups. Assessment of a possible rebound effect within 2 weeks of total lockdown found an increased incidence of the children burn consultation, an increased number of older children and mainly male. CONCLUSION: The decrease in the number of consultations alerts us to a potential increase in the functional sequelae of burns in these patients at risk. Longer-term follow-up will allow us to assess the consequences of this lockdown on this particularly at-risk population.

[Reanimation de l'extension du pouce par transfert de l'extensor indici proprius chez les enfants atteints de pouce flexus adductus congenital]. / Réanimation de l'extension du pouce par transfert de l'extensor indici proprius chez les enfants atteints de pouce flexus adductus congénital.

Congenital clasped thumb is a rare congenital deformity characterized by a permanent contracture of the thumb metacarpo-phalangeal joint. Surgical option often raise in case of failure of the orthopaedic method. We wanted to evaluate the use of the extensor proprius indici (EPI) tendon to reanimate thumb extension in children affected by congenital clasped thumb. We made a retrospective review of children operated in our center between 2005 and 2019. We operated eight children (twelve hands) over this period: nine were grade I, two grade II and one case grade III (arthrogryposis). Medium age at surgery was 18 months (10 to 23 months). In each case, EPI tendon transfer was realized and sutured to the extensor pollici longus. Children were seen in consultation at six weeks postoperative and then mean follow-up was nineteen months. Seven children (87.5%) had a physiologic thumb extension at six weeks. One case of partial loss of extension on the index was noted. One second time of surgery was necessary to change the course of EPI transfer. At six months postoperative, all children could use their thumb with an extension similar to the opposite thumb. Surgery must be proposed in congenital clasped thumb persistent after at least four months of orthopaedic treatment or in cases of severe deformity. Tendon transfer using EPI must be proposed first given the good functionnal results and low morbidity.

Reverse Lip Lift For Deep Face Burn Sequelae With Bilateral Nostril Stenosis And Lip Contracture: An Original Technique. A Case And Literature Review.

Bilateral nostril stenosis resulting from deep facial burn that occurred on an oxygen-requiring patient with tobacco use is life threatening with obstruction of the airway and impossibility of oxygen supplementation use. We report the case of a deep burn involving the nose and the upper lip during oxygen and tobacco use with a severe bilateral nostril stenosis and upper lip retraction. We did a reverse bullhorn lip lift with bilateral alar base transposition realized in a one-stage surgery with nasal conformer for 4 months. Surgery allowed a significant opening of the nostril stenosis with a 9mm and 11mm major axis on the right and left side respectively. It brought restoration of the ability to nose breath and use an oxygen device, and was considered satisfactory by the patient and the operators. There was no recurrence at 18-month follow-up. Literature provides few examples of management of severe bilateral nostril stenosis following facial deep burn. Nasal conformers with progressive diameter augmentation, rhinoplasty procedure, local plasties, dermal flap, skin and composite grafts can treat this situation but there is no gold standard procedure. Reverse bullhorn lip lift with bilateral alar base transposition makes it possible to correct this severe deep burn sequela. With this clinical case, we show the possibility to treat it in a one-stage procedure through an aesthetic procedure inspiration, with an acceptable scar on the donor site.

La survenue d'une sténose narinaire bilatérale après une brûlure profonde de la face, chez un patient oxygénodépendant et fumeur, impacte le pronostic vital, par obstruction des voies aériennes supérieures et impossibilité d'utiliser l'oxygénothérapie. Nous rapportons le cas d'une brûlure profonde du nez et de la lèvre supérieure survenue en fumant pendant l'oxygénothérapie, entraînant une importante sténose narinaire bilatérale et une rétraction de la lèvre supérieure. Nous avons réalisé un lifting labial en corne de buffle inversé avec transposition bilatérale des ailes narinaires en un seul temps opératoire. Un conformateur narinaire a été porté pendant quatre mois. Cette chirurgie a permis une ouverture significative des sténoses narinaires, avec 9 mm et 11 mm de grand axe transversal respectivement à droite et à gauche. Cela a permis de restaurer la fonction respiratoire nasale et de permettre le port du masque à oxygène. Le résultat a été jugé satisfaisant par le patient et par les opérateurs. Nous n'avons pas noté de récidive à 18 mois de la chirurgie. La littérature rapporte peu de cas de sténose narinaire bilatérale après brûlure profonde de la face. Des conformateurs narinaires de diamètre progressivement croissant, des techniques type rhinoplastie, des plasties locales, des lambeaux cutanés, des greffes cutanées ou composites ont été décrites mais il n'y a pas de consensus. La technique de lifting labial en corne de buffle inversé associée à une transposition des ailes narinaires nous a permis de traiter ces séquelles de brûlure profonde. À travers ce cas cliniques, nous montrons la possibilité de traitement en un temps par une technique inspirée des techniques de chirurgie esthétique et avec un résultat cicatriciel acceptable.

[The de-epidermized sural flap: An original technique to increase the reliability of the neurocutaneous sural flap]. / Le lambeau sural désépidermisé : technique originale de fiabilisation du lambeau neurocutané sural.

BACKGROUND: The neurocutaneous sural flap is useful to cover defects of the distal quarter of the lower limb. Nevertheless, severe complications occur in 14% of the cases, and venous congestion is reported in 75% of these cases. This congestion can lead to total necrosis of the flap and a failure of the procedure. We describe a new surgical method aiming to reduce the risk of venous congestion occurrence and failure of the defect coverage. PATIENTS AND METHODS: We realized a retrospective study of patients who undergone a de-epidermized distally based neurocutaneous sural flap in our surgery department from 2015 to 2020. The following data were collected: sex, age, vascular risk factors, size of the wound, defect area, etiology, delay between the surgery of the flap and the split-thickness skin graft and complications. RESULTS: The cohort is composed of 5 cases. We reported no failure of the coverage of the defect. There were no cases of venous congestion. CONCLUSION: The de-epidermized distally based neurocutaneous sural flap could increase the reliability of these flaps by reducing the risk of venous congestion. A larger study comparing the classic technique to the de-epidermized sural flap could confirm these data on a greater number of cases and position this technique in the therapeutic arsenal.

[Hospitalisations Related To Burns In France. Analyses Of 2019's National Data Base]. / Hospitalisations Pour Brûlure En France. Données 2019 Extraites De La Base PMSI Nationale.

Thanks to the Medical Information Service of our institution, we obtained the data on burns during 2019, saved in the national database. We found 10,913 reports, among them 10,347 metropolitan and 566 overseas. When compared to the French population on January 1st 2020, the incidences were 16 (global population); 15.7 (metropolitan) and 27.1 (overseas)/100,000 inhabitants respectively. The majority (62.95%) of the patients were taken care of in Burn Centres (BCs). However, 4,043 patients were never seen by a burn specialist. Nevertheless 88.54% of skin grafts were performed in BCs and 71.86% of the burns with high seriousness (levels 3 and 4) were in BCs. One hundred and seventy-nine patients (1.64%) died. For the first time, we obtained the intensive care activity, through the scoring actions. Intensive care was held for 958 patients (8.96%), 90.81% of them in a BC. Only 28.57% were associated with major (>30% BSA) burns, but these major burns accounted for 63.78% of the organ failure treatments.

[Median nerve compression in the carpal tunnel in children - a delayed diagnosis. About 20 clinical cases]. / La compression du nerf médian dans le canal carpien chez l'enfant ­ un diagnostic retardé. À propos de 20 cas.

OBJECTIVES: The carpal tunnel syndrome is rare in children. We performed a retrospective study of 10 children. The aim is to show that the diagnosis of carpal tunnel syndrome is difficult in children. PATIENTS AND METHODS: We identified all children with median nerve compression in the carpal tunnel between 2010 at 2020, managed in our service. RESULTS: Ten children with 20 hands included. There was different etiologies of carpal tunnel syndrome: 5 lysosomal storage diseases, 4 idiopathic carpal tunnel syndrome, 1 genodermatose, 1 Byler syndrome and 1 VACTERL syndrome. Common presenting symptoms were pain (five patients) and under use of fingers (five patients). Two children had opposition deficit of the thumb. We operated 19 hands. Median age at diagnosis was 4 years and 7 months. One children or 2 hands had a reanimation of opposition by tendinous transfer of flexor digitorum superficialis tendon of the ring finger. All children had a complete regression of the painful symptoms, a use improvement of fingers and recovery of the opposition of the thumb. CONCLUSION: The diagnosis of carpal tunnel syndrome is difficult in children. It is common to be confronted with an advanced clinical symptoms. The atypical symptoms may cause diagnostic delay. Due to the quality of the clinical results obtained, we recommend open carpal tunnel release even when the diagnosis seems delayed. LEVEL OF EVIDENCE: IV.

Negative Pressure Wound Therapy in children: A 25 cases series.

Negative Pressure Wound Therapy is a device applied to a wound that causes local depression. There are a few series showing the effectiveness of this treatment in Pediatric. The objective of this work is to try to clarify the indications in children. This is a retrospective series of 25 children between 2004 and 2019. The inclusion criteria were all children with a wound treated with Negative Pressure Wound Therapy. The characteristics retained were their age, the context of occurrence, the treatment time, the depression applied, the technique of skin covering wound and the average healing time. We included 25 patients. The average age was 8.8 years. The context of the wound occurrence was mainly a road (44%) or a domestic (36%) accident. Substance losses were mainly located in the lower limb (84%). The depression applied was -90mmHg. The healing time was 18.4 days. Thin skin grafting was the main method chosen (88%). No complications related to Negative Pressure Wound Therapy equipment have been identified. Despite the weakness of the literature and the lack of consensus regarding its use, Negative Pressure Wound Therapy is an essential therapy in pediatric. It is a simple and effective technique in children. It can reduce the need for flaps coverage, even in the event of exposure of noble elements. The flaps should not, however, be excluded from the decision-making algorithm, on pain of complications or sequelae.

Evaluation of satisfaction and well being with Breast-Q© of aesthetic breast augmentations by implants using the "Dual Plane" technique: A serie of 191 cases.

INTRODUCTION: Dual Plane allows, according to J.B Tebbetts, to combine the advantages while reducing the drawbacks of the other implantation pockets. We assessed patient satisfaction using the Breast-Q © questionnaire after breast augmentation using the Dual Plane technique. MATERIAL AND METHODS: Our study involved evaluating data from the Breast-Q © questionnaire from 191 patients retrospectively. Other secondary criteria were studied such as postoperative complications, the correlation between satisfaction and implant volume, satisfaction and operating time, satisfaction and age of the patient. RESULTS: The Breast-Q © questionnaire allows us to assess the satisfaction of the patients in our series about their breasts, their implants, the information received and the outcome of the intervention. Physical, sexual and psychosocial well-being is also assessed. CONCLUSION: Breast augmentation using a Dual Plane pocket according to Tebbetts achieves significant levels of satisfaction and well-being in patients. To our knowledge, this is the most important series devoted to the evaluation of these criteria after the use of the Dual Plane.

Management of loss of tissue substance in children's limbs. What are the salient peculiarities? A proposed algorithm.

Loss of tissue substance in children's limbs has the same etiologies and in many cases, the same severity as in adults' limbs, and the means placed at the disposal of a surgeon are likewise comparable. It may nonetheless prove difficult to strategically position the different treatment methods in a decision-making tree. After all, a child presents numerous peculiarities: high quality of vascularization (both microcirculation and macrocirculation), better ability to achieve nerve regeneration and durable bone consolidation and, last but not least, a pronouncedly superior overall functional prognosis. Moreover, a child's future needs to be taken into account ; it is not only cicatrization per se, but also the quality of healing that should dictate therapeutic choices, which will consequently be determined in view of avoiding functional disorders during the growth process. On the basis of their experience and following a review of the literature, the authors have assessed the interest of each relevant technique and drawn up a decision-making tree.

Long-term behavior of the vascularized fibular free flap for reconstruction of bony defects in children.

OBJECTIVE: Bony resection in children presents a unique reconstructive challenge because of future growth potential. To achieve limb salvage and provide the patient with a functional extremity, vascularized free fibula transfer has become the workhorse for bony reconstruction. The authors present their reconstructive experience using vascularized fibula flaps in a group of pediatric patients. PATIENTS AND METHOD: This is a monocentric, retrospective study of 25 pediatric patients who underwent reconstruction of bony defects with a vascularized fibula flap from 2004 to 2017. Perioperative and long-term complications were noted. Functional outcomes were analyzed. RESULTS: Twenty-five patients with a mean age of 10 years were included. The etiology was tumor for 21 of them and 4 had neurofibromatosis. Median follow-up was 86 months. Overall, survival was 92 percent and flap survival was 100 percent. Perioperative surgical complication rate was 32 percent. The overall union rate was 87 percent following supplemental bone grafting. 67 percent of the lower limb fibula presented hypertrophy, with a mean hypertrophy of 154 percent. Median time to union was 15 months. Leg-length discrepancy was present in 5 patients. Mean Musculoskeletal Tumor Score was 23. CONCLUSION: Vascularized fibula free flap is the ideal material for long bone reconstruction with a definitive result. It allows children with early ambulation, provides good functional outcomes and improve their quality of life.

[Use of methoxyflurane on acute pain during burn dressing in adult consultation]. / Utilisation du méthoxyflurane sur la douleur aiguë lors du pansement en consultation des brûlés adultes.

INTRODUCTION: The objective was to compare the short-term efficacy of methoxyflurane vs. MEOPA on acute pain during burn dressing in consultation, the secondary outcome was to assess the patient's comfort and the quality of the dressing performed. MATERIALS AND METHODS: Monocentric, prospective study from April 2018 to January 2019. Men and women>18 years presenting acute burn on<10% SCT were included. A pain≥4 on the numerical scale (from 0 to 10) at the beginning of the treatment established the indication of methoxyflurane or MEOPA, with randomization done by a nurse. The following data were collected: burn description, performed debridement, pain assessment by numerical scale: on arrival, at the beginning of care, after 6 to 10 inhalations for methoxyflurane or 3 to 4minutes of inhalation for MEOPA and at the end of care. RESULTS: Sixty patients were included, 30 in each group. There was a decrease of -2.47 points of numerical scale when initiating methoxyflurane against -1.53 points for MEOPA (P=0.08). Patients were significantly less painful when stopping treatment in the methoxyflurane group -4 points vs -2 points (P=0.001). Methoxyflurane significantly improved the debridement of the burn (P=0.018). CONCLUSION: Methoxyflurane is more effective than MEOPA in acute pain in burn dressing, improved patient comfort, and improved dressing quality.

[Burns by immersion in children and abuse]. / Brûlures par immersion chez l'enfant et maltraitance.

AIM OF THE STUDY: Ten percent of childhood burns could arise from maltreatment. While describing 6 severe cases of inflicted scalds by immersion in children, we expose our systematic diagnostic approach of abuse and confirm the serious nature of burn when they are inflicted. PATIENTS AND METHOD: The retrospective study concerned children hospitalized for scalds by immersion between 2013 and 2016 and for whom child abuse has been confirmed. Sex, age, burns description, needs of surgery, length of stay at hospital and protection plan set up were collected. RESULTS: Six cases of burns by immersion due to maltreatment were identified (5 boys, 1 girl) with a median age of 12 months. The average total burn surface area was 19%. Burns were of deep second and third degree and always symmetric. Every child underwent surgery at least once. Concern information was transferred for all of them. CONCLUSION: Teams taking care of children with burns must be trained to the difficult diagnostic of abuse or neglect so that early social interventions can be set up in case of maltreatment.

[Proposal of guidelines for antibiotic prophylaxis in plastic, reconstructive, and aesthetic surgery]. / Proposition de recommandations sur l'antibioprophylaxie en chirurgie plastique, reconstructrice et esthétique.

BACKGROUND: In plastic surgery, guidelines about antibiotic prophylaxis are inaccurate and incomplete, due to result the absence of high-level studies on this subject. The main aim is to establish national common recommendations for plastic surgery antibiotic prophylaxis. MATERIALS AND METHODS: A working group will discuss and validate a multi-center analysis of practices in three University Hospital Centers compared to an interdisciplinary analysis of recommendations to the French Society of Anaesthesia and Intensive Care Medicine and scientific literature. This working group is composed of plastic surgeon members of the French Society of Aesthetic Reconstructive Plastic Surgery, infectious disease physicians, and anaesthesiologists to define clear and precise antibiotic prophylaxis recommendations. RESULTS: Antibiotic prophylaxis with cefazoline (or clindamycine±gentamicine in case of allergy), has been recommended for general surgery with flap or implants, for breast surgery, lipofilling, and rhinoplasty. In other plastic surgery, no antibiotic prophylaxis has been recommended. CONCLUSION: We established common recommendations for plastic surgery antibiotic prophylaxis that is the first step to update these recommendations. Now, they can be evaluated in clinical situation to validate them.