Surgical practices of cosmetic breast augmentation by implants among 411 French plastic surgeons.

INTRODUCTION: Breast augmentation is one of the most frequently performed cosmetic surgeries in the world. However, there is no standardized surgical procedure for performing breast augmentation. Many modalities exist for this surgery which may explain why practices vary greatly from one surgeon to another. The aim of this study was to evaluate current practices of breast augmentation by implant in France and changes in practices among French plastic surgeons. MATERIAL AND METHODS: This observational study was conducted between February 2020 and January 2021. An online questionnaire with 62 questions was sent to 729 French plastic surgeons. The questions concerned: the population of surgeons interviewed, pre-operative aspects, surgical technique and post-operative management. RESULTS: 411 plastic surgeons responded, 5.1% of surgeons impose a nicotine screening test on patients. 99.76% and 95.59% reported that they used silicone gel implants and round prostheses. All used smooth or micro-textured shells. The inframammary approach was the most used by 66.2% of plastic surgeons. The implants placed were between 250 and 300 cc on average and were mainly placed in "Dual plane" by 42% of surgeons. In order to reduce bacterial contamination, 26% of surgeons soaked the implants in a povidone-iodine solution and 23% used an insertion sleeve. The most frequent early complication was hematoma, while capsular contracture was a late complication. CONCLUSION: This study provides new data on current surgical practices of breast augmentation in France, allowing more informed choices and opening up perspectives for more standardized practices in the future.

[Breastfeeding after breast surgery]. / L'allaitement après une chirurgie mammaire.

Young women who have malformative breasts logically ask themselves the question of the functionality of their mammary gland and future breastfeeding. Several surgical techniques are possible and the ones that seem to hinder breastfeeding the most are breast reduction and breast prosthesis. Insufficient lactation is a quantitative milk disorder where the mother is unable to ensure sufficient milk production or transfer. It's clear that the calculation of its rate is today the best indicator to evaluate the lactation function. There are still very few studies using this criterion, but their results confirm an alteration in lactation whether after reduction or augmentation breast surgery. It's important to inform patients of the difficulties they may encounter, a high probability of mixed breastfeeding and a shorter duration. But also on the effects that a pregnancy can have on the aesthetic result: decrease of firmness, ptosis, modification of the volume.

Innervation of digital joints: an anatomical overview.

INTRODUCTION: The innervation of the digital joints as well as the anatomical relationships of the articular branches is present in this anatomical work to determine the technical feasibility of a selective and efficient denervation of the digital joints. MATERIALS AND METHODS: A study of 40 distal interphalangeal (DIP), 40 proximal interphalangeal (PIP), 50 metacarpophalangeal (MCP), 10 interphalangeal (IP) of the thumb, and 10 trapezo-metacarpophalangeal (TMC) joints was performed on ten hands. Under magnification and a proper surgical approach, we collected the course, the source origin, the number of articular nerve branches, and their caliber. RESULTS: In total, 118 nerve branches arising from the proper palmar digital nerves were found on 10 DIP of each dissected long finger (n = 40). A total of 226 nerve branches were found on 10 PIPs of each long finger (n = 40), of which 204 branches (90.3%) had a palmar origin. Dorsal innervation was found for the ring and little finger, originating from the dorso-ulnar digital nerve. 212 branches were found on 10 MCP of long fingers (n = 40), including 87 branches of palmar origin (41.1%), 107 branches of dorsal origin (50.4%), and 18 branches of the motor branch of the ulnar nerve (8.5%). 42 articular branches directed to the TMC joint (n = 10) were found. 13 branches (31%) originated from the anterior sensory branch of the radial nerve, 13 branches (31%) originated from the lateral cutaneous nerve of the forearm, 5 branches (12%) originated from the palmar cutaneous branch of the median nerve, and 11 (26%) branches originated from the thenar branch of the median nerve. The involvement of the sensory anterior branch of the radial nerve was always present for the innervation of each TMC. DISCUSSION AND CONCLUSION: Our research shows that finger joints receive their primary innervation from small branches of the digital nerves with the exception of the MCP joint and the TMC joint. To obtain an efficient and a selective digital denervation for articular pain relief, it is necessary to plan the best surgical approach and it is crucial to recognize the articular nervous branch localization and source.

[Dorsal skin defect: What solutions exist?] / Perte de substance cutanée médiane du dos : quelles solutions s'offrent à nous ?

Dorsal subcutaneous or cutaneous defects can be of multiple origin: tumor, congenital malformation, trauma, chronic radiodermitis ulceration, parting of sutures or spine surgery infection, pressure sore, etc. Wound healing of these defects can be really difficult to obtain with simple processes, such as direct sutures or skingrafts, and often implies skin flap surgery. The rarity of recipients vessels from the dorsal area makes free flaps surgery harduous. Various local or locoregional back cover solutions are available: muscular or musculocutaneous flaps (latissimus dorsi, trapezius muscle, spinal muscles, gluteus maximus), perforator flaps (DICAP, DLICAP, SCAP and IGAP…), random flaps. These flaps are really useful and must be mastered in order to propose the best-suited cover solution for each patient after a precise evaluation of their medical and clinical background. Our study, based on the Literature and some clinical cases, aims to draw up a complete table of local, locoregional and microsurgical coverage solutions by anatomical area for median and paramedian back wound defects and thus to produce a decisional algorithm facilitating our care.

Nostril Surgery: Indications, Surgical Procedures and Outcomes-A Systematic Review of Published Cases.

INTRODUCTION: To achieve adequate nasal proportions, nostril surgery can be a complementary technique useful in facial surgery. To help surgeons with the decision to realize nostril surgery, we conducted a systematic review to summarize reported cases on surgical procedures with a specific interest on indications, surgical procedures and postoperative outcomes. A therapeutic algorithm is also proposed. METHOD: We carried out this review in accordance with the PRISMA criteria. Twenty-two eligible studies were identified using Medical databases, including 1599 patients. A qualitative and quantitative analysis was carried out. DISCUSSION: Excision techniques were realized on 728 patients (45.5%), followed by cinching sutures on 642 patients (40%) and combined techniques: excision techniques with flap advancement techniques in 189 cases (12%), excision techniques with flap advancement techniques and cinching suture in 40 patients (2.5%). When excessive alar flaring was present, alar wedge resection was preferred in the 92% of followed by alar and sill resection. Cinching sutures were realized when excessive alar flaring was associated with a vertical alar axis, in cases of wide alar base, of associated orthognathic surgery. When excessive alar flaring was associated with wide alar bases, indications changed basing on the associated deformities. In 795 patients, nostril surgery was conducted simultaneously with rhinoplasty. CONCLUSION: Nostril surgery through excision techniques, cinching sutures or flaps advancement techniques, reveals good outcomes and can be complementary to rhinoplasty or orthognathic surgery. Through this systematic review, we tried to orient surgeons to find the best treatment for nostril base surgery. LEVEL OF EVIDENCE III: 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 .

Vascularization of the superficial circumflex iliac perforator flap (SCIP flap): an anatomical study.

INTRODUCTION: The superficial circumflex iliac artery perforator flap (SCIP) has gained widespread popularity as local or free flap to cover soft tissue defects. However, there are numerous anatomical variations in terms of size, location and reliability of its perforators This cadaveric study aimed to focus on the anatomical bases of this flap. MATERIALS AND METHODS: A bilateral dissection of seven cadavers was performed to harvest 14 flaps. Superficial circumflex iliac artery parameters, number, length and diameters of perforators were measured. Correspondent perforasomes were highlighted through semi-selective injections. RESULTS: The major perforator of the superficial branch had a mean caliber of 2.0 mm, and a mean length of 1.8 mm. The major perforator of the deep branch had a mean caliber of 2.1 mm and a mean length of 1.43 mm. The mean area of the superficial pattern perforasome was 178.6 cm2 and the mean measured surface of the deep pattern perforasome was 156.2 cm2. The descending branches of the deep branch anastomosing with the ascending branch of the lateral circumflex femoral artery were found in three cases. CONCLUSION: Several anatomical variations were observed in this anatomical study, but major perforators supplying large perforasomes were always found.

Coverage losses of substance in the shoulder.

Losses of substance of the shoulder are less common than elsewhere in the upper limb. They arise essentially from tumors (sarcomas), infectious diseases (hidradenitis) or traumatic events, (burns). The objectives of reconstruction depend on whether the losses of substance are located on the curve of the shoulder or in the axillary area. There exist numerous regional solutions, including perforator, propeller, pedicled and free flaps. The donor region may be the thorax (latissimus dorsi, serratus anterior), the back (trapezium, scapular or subscapular flaps, occipito-cervico-thoracic flap), the anterior surface of the thorax (pectoralis major or minor, supraclavicular, perforators of the acromiothoracic artery, delto-pectoral flap) or arm (brachial lateral or medial). Multitissular reconstructions are also possible in regional and pedicled form, as well as microanastomosed flaps in exceptional conditions.

Anatomy of the cutaneous lymphatic system of the trunk: a clinico-anatomical study of 90 cutaneous melanomas.

PURPOSE: The cutaneous lymphatic system of the trunk is a complex network, the anatomical knowledge of which remains unclear. The lymphatic system plays a major role in the dissemination of lymphophilic cancers like melanomas. The aim of this study was to improve our knowledge, optimize the care of patients with cutaneous tumors of the trunk, and to use our clinical experience of the topography of pathologic lymph nodes related to cutaneous melanomas and depicted by lymphoscintigraphy. MATERIALS AND METHODS: This prospective study included 90 consecutive patients who had primary resection of cutaneous melanoma of the trunk between June 2011 and January 2015. All patients had lymphatic mapping by lymphoscintigraphy, followed by sentinel lymph node procedure. We compared data of lymphatic imaging (lymphoscintigraphy and SPECT-CT) and surgery. We divided the trunk into 36 regions based on cutaneous anatomical landmarks to determine the topography of the lymphatic system for each tumor. RESULTS: Our study showed cutaneous lymphatic drainage of melanomas of the trunk in 16 different areas. This drainage could be single or multiple. We observed that drainage could be controlateral in medial regions of the trunk, and lymphatic pathway could be retrograde. This drainage could be bilateral for medial regions and mainly into axillary areas for regions above L1 level. Posterior regions of the trunk had more diversity of drainage areas than anterior regions. CONCLUSIONS: Cutaneous lymphatic drainage of the trunk was not limited to axillary and inguinal areas, showed interindividual variability, and was single or multiple, unilateral or bilateral, and unpredictable.

A preoperative cotininury test for abdominoplasty reduces peri-operative complications.

BACKGROUND: Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. MATERIAL AND METHODS: This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. RESULTS: Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001). CONCLUSION: The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking.

[Annular lipoatrophy of the ankles treated by fat grafting: Case report and review of the literature]. / Lipoatrophie annulaire des chevilles traitée par autogreffe de tissu graisseux : à propos d'un cas et revue de la littérature.

INTRODUCTION: Annular lipoatrophy of the ankles is a rare disease. Eleven cases are described in the literature. CASE REPORT: We report the case of a 10-year-old girl having an annular lipoatrophy of the ankles. The clinical history begins with the appearance of inflammatory infiltrated nodules at the two legs, which have evolved in a few months to a circumferential lipoatrophy of the ankles. Laboratory studies showed a very high antistreptolysin O titer, concluding streptococcal origin of this hypodermitis. After two years of stable lesions, the patient received two sessions of fat injection. RESULT/DISCUSSION: A satisfactory outcome of the adipocyte graft was observed with reconstitution of shapely legs, stable over time. Eleven cases described in the literature are found. It is a pediatric pathology seen predominantly in female children. The evolution towards lipoatrophy is systematic with or without treatment initiated at the inflammatory phase. We first discuss the management of aesthetic sequelae of this disease. CONCLUSION: Fat grafting appears to be a good indication for the treatment of the cosmetic sequelae seen in annular lipoatrophy of the ankles.

[Osteo-cutaneous Mycobacterium marinum infection of the elbow and reconstruction with radial collateral artery perforator-based propeller flap]. / Infection ostéo-cutanée du coude à Mycobacterium marinum et reconstruction par un lambeau en hélice basé sur une perforante de l'artère collatérale radiale postérieure.

Mycobacterium marinum is an atypical and non-tuberculosis mycobacterium that mainly leads to cutaneous infections. Infections occur through inoculation of the organism through injury to the skin in the presence of contaminated water or fish. The patient often presents with unspecific symptoms and the evolution, in the absence of adequate treatment, is characterized by an expansion of the cutaneous lesion and a spread to deep structures. Infections of tendon sheaths and joints are described, rarely osteomyelitis. Sure diagnosis is hard to obtain and is established from the medical history and microbiological examination. There are no specific therapeutic guidelines. Double or triple antibiotherapy is often effective and should be continued several months after complete resolution of clinical signs. Surgical debridement is required in cases of invasive or resistant infections. We report the case of a young immunocompetent fishmonger with a rare osteocutaneous M. marinum infection of the elbow. Treatment included large surgical excision of infected skin and bone areas and a triple antibiotics administration. Reconstruction have been ensured by a radial collateral artery perforator-based propeller flap, satisfying appropriates functional and cosmetical concerns of this anatomical region. Surgery and appropriate antibiotics treatment were effective and allowed healing of an invasive cutaneous and bone M. marinum infection.

[Axillary web syndrome following axillary lymph node dissection for melanoma: 5 cases]. / Syndrome de la corde axillaire après chirurgie ganglionnaire dans un contexte de mélanome : 5 cas.

BACKGROUND: Axillary web syndrome is a rare disease similar to Mondor's disease and is usually seen after axillary surgery. Herein, we describe five new cases, all of which occurred in a setting of melanoma. PATIENTS AND METHODS: Five patients presented axillary web syndrome following sentinel node surgery, adenectomy or axillary curettage in a setting of melanoma. Therapy involving analgesics and physiotherapy to snap the cord-like structure helped accelerate resolution. DISCUSSION: Some debate continues to surround the physiopathology of axillary web syndrome in the literature, particularly regarding its relationship with Mondor's disease, which is considered to result from superficial venous thrombosis. The lymphatic and myofascial explanation for the syndrome appears to us to be more coherent and justifies the non-aggressive therapeutic approach we adopt for our patients, who receive assurances about the benign nature of their condition and the absence of sequelae. CONCLUSION: Axillary surgery in patients presenting melanoma appears to be a risk factor for axillary web syndrome. No relationship has as yet been demonstrated between this syndrome and the presence of axillary metastases.

[Abdominoplasty complications: particularities of the post-bariatric patients within a 238 patients series]. / Complications des abdominoplasties: particularités des patients post-bariatriques au sein d'une série de 238 patients.

BACKGROUND: Obesity is one of the health issues that is recently worldwide increasing, as well as in France. Variety of procedures of bariatric surgery have been developed over the past decade and are performed for morbid obesity hence. The demand of plastic surgery increased for body contouring and reshaping after dramatic weight loss, in which the abdominoplasty is considered as one of the most common procedures. The purpose of this study is to clarify the differences between the post-bariatric patients and others, and their influence on the occurrence of complications following abdominoplasty. PATIENTS AND METHODS: Retrospective study involving a group of post-abdominoplasty patients collected from the same center between January 2000 and December 2010. RESULTS: Among 238 reviewed patients' files; 114 of them are post-bariatric patients, and 124 are non-bariatric patients. Several differences were found between these two groups of patients including the maximum BMI, BMI at the time of surgery, the rates of cardiovascular risk factors, and a longer operative time in the post-bariatric group. The complication rate in these patients was significantly higher (55.3% against 26.6%) with mainly healing problems. Major maximum weight, obesity at the time of surgery, long operative time and postoperative drainage system are all considered as risk factors, which carry high rate of complications. CONCLUSION: It appears that abdominoplasty in post-bariatric patients requires specific care because of particularities inherent in this population.

[Alopecia reconstruction by expansion after a scalp burn injury caused by Taser(®): a case report]. / Reconstruction avec prothèse d'expansion d'une alopécie secondaire à une brûlure du cuir chevelu par Taser(®)

BACKGROUND: Scarring alopecia resulting from burns may be difficult to treat and involves various plastic surgery techniques such as expanded scalp flaps. OBSERVATION: Herein, we report the case of a 19-year-old male patient who suffered burning of the scalp with scarring alopecia following an attack with a Taser(®) electrical gun. Given the extent and site of alopecia, we decided to create a prosthesis by means of scalp expansion. The cosmetic result was satisfactory. DISCUSSION: Several scalp reconstruction techniques have been described for scarring alopecia, with the most widely used being expansion, scalp flaps, repeated excision and hair implants. CONCLUSION: The present case suggests that scalp expansion offers an effective method for the reconstruction of scarring alopecia following burns with a Taser(®) device.

[Staphylococcus lugdunensis necrotizing fasciitis after abdominal dermolipectomy: report of two cases and review of the literature]. / Fasciites nécrosantes à Staphylococcus lugdunensis après dermolipectomie abdominale : à propos de deux cas et revue de la littérature.

Necrotizing dermohypodermitis is a severe and potential fatal infection of soft tissues. We report two cases of 39- and 41-year-old patients operated of abdominal dermolipectomy and liposculpture after bariatric surgery. Because of a body mass index (BMI) less than 35kg/m(2), and trouble of interpretation of the SFAR recommendations, we have not achieved antibiotics. These patients presented an abdominal necrotizing dermohypodermitis at Staphylococcus lugdunensis, requiring wide excision of necrosis in emergency. The suites have been favorable after surgical and medical care. Perineal proximity, skin and subcutaneous peeling appear to be significant risk factors for this pathology. We suggest if case of abdominal dermolipectomy preventive measures in skin preparation and systematic antibiotics regardless of BMI. Indeed, the risk of a necrotizing dermohypodermitis recalls the importance of rigorous prevention and early diagnosis.

[Necrotizing dermohypodermitis of the abdominal wall in obesity. Two cases indicative of abdominopelvic deep infection]. / Dermo-hypodermites nécrosantes du tablier abdominal chez l'obèse. À propos de deux cas cliniques révélateurs d'infections profondes abdomino-pelviennes.

Necrotizing dermohypodermitis of abdominal wall in obese is a rare disease with high mortality. We report two cases of 50 and 62years old patients whose intra-abdominal infectious pathology (appendicular abscess for one and pyosalpinx for the other) was revealed by a necrotizing dermohypodermitis of the abdominal wall. The diagnosis has been established on the basis of converging clinical arguments (abdominal pain, crackles and necrotic appearance of abdominal wall in a septic shock context), linked with a CT-scan. The treatment consisted of a large excision of the abdominal wall necrosis and surgical eradication of deep infection source, with an intensive care and a broad spectrum antibiotic therapy. Both these patients present morbid obesity (BMI>40) whose implication must be taken into consideration in the way the disease appears. Indeed, the necrotizing dermohypodermitis of abdominal wall in these patients must lead first in looking for a deep infection with few symptoms. It must be identified quickly to propose an early and multidisciplinary surgical treatment.

Stromal vascular fraction in the treatment of myositis.

Muscle regeneration is a physiological process that converts satellite cells into mature myotubes under the influence of an inflammatory environment progressively replaced by an anti-inflammatory environment, with precise crosstalk between immune and muscular cells. If the succession of these phases is disturbed, the immune system can sometimes become auto-reactive, leading to chronic muscular inflammatory diseases, such as myositis. The triggers of these autoimmune myopathies remain mostly unknown, but the main mechanisms of pathogenesis are partially understood. They involve chronic inflammation, which could be associated with an auto-reactive immune response, and gradually with a decrease in the regenerative capacities of the muscle, leading to its degeneration, fibrosis and vascular architecture deterioration. Immunosuppressive treatments can block the first part of the process, but sometimes muscle remains weakened, or even still deteriorates, due to the exhaustion of its capacities. For patients refractory to immunosuppressive therapies, mesenchymal stem cells have shown interesting effects but their use is limited by their availability. Stromal vascular fraction, which can easily be extracted from adipose tissue, has shown good tolerance and possible therapeutic benefits in several degenerative and autoimmune diseases. However, despite the increasing use of stromal vascular fraction, the therapeutically active components within this heterogeneous cellular product are ill-defined and the mechanisms by which this therapy might be active remain insufficiently understood. We review herein the current knowledge on the mechanisms of action of stromal vascular fraction and hypothesise on how it could potentially respond to some of the unmet treatment needs of refractory myositis.

[Biometric and morphometric analyse of the umbilicus: about 70 cases]. / Analyse biométrique et morphométrique de l'ombilic. À propos de 70 cas.

PURPOSE OF THE STUDY: More than the first scar present from the birth, the umbilicus is the original and fundamental element, which characterizes the abdomen. It can be analyzed under various aspects: symbolic, artistic, anatomical and morphometric. Its place takes on all its importance in frame of the abdominal plastic surgery. We tried to measure how the position of the umbilicus varies with the age, the weight or the sex… to optimize our abdominoplasties. PATIENTS AND METHOD: We realized a study on the umbilicus from 70 persons to determine its abdominal position in the general population. Some objective measurements between bones projections and umbilicus were realized and analyzed with various parameters (weight, age especially…). Depth of the umbilicus, its situation compared the median line, its dimensions, were noted for each patient. RESULTS: Population was composed of 39 women and 31 men, 35.4 years on average. The umbilicus was measured one centimeter under the line joining the top of the iliac crest. In the group of men, its situated lower. We noted a positive correlation between body mass index (BMI) and height of the umbilicus. More the BMI increases, lower is the umbilicus (R=0,72, P<10(-5)). Similarly, the umbilicus is lower when the age increases (R=0,36, P=0,0022). Its average depth was 15 mm, correlated to BMI (R=0,60, P<10(-7)). Some data about dimensions and form were precised. CONCLUSION: This anatomical and morphometric study could allow a more precise determination of the position, dimensions and form of the umbilicus during abdominoplasty.

[Breast augmentation by Poly Implant Prothèses silicone implants: retrospective study about 99 patients. Rupture analysis and management]. / Augmentation mammaire par prothèses en gel de silicone de la marque Poly Implant Prothèses (PIP) : étude rétrospective de 99 patientes. Analyse des ruptures et prise en charge.

BACKGROUND: Breast augmentation is one of the most frequent intervention in plastic surgery. In March 2010, the Afssaps has withdrawn from the market all the Poly Implant Prothèses (PIP) silicone implants, the authors report a retrospective study of 99 patients who had breast augmentation by PIP implants. The aims of this work are to evaluate the ruptures observed with these implants and to propose a management. METHODS: We included in the study 99 patients and 192 silicone gel implants. The interventions were performed between 2005 and 2010. On 192 implants, 184 had a textured surface and eight a smooth one. According to the latest recommendations from the Afssaps, all patients had a clinical examination and an ultrasonography looking for rupture signs. MRI was performed in case of doubt. RESULTS: We found 23 ruptured implants: 18 intracapsular and five extracapsular ruptures, involving 17 patients. We also found 28 patients with axillary lymphadenopathy and eight patients with locoregional silicone spread. Finally, we found that 35 patients had chronic breast pains. CONCLUSION: Given our results, it seems reasonable to withdraw all the PIP silicone breast implants.

[Identification of factors associated with performance in objective structured clinical examination in Rouen medical school]. / Identification des facteurs associés à la réussite aux examens cliniques objectifs et structurés dans la faculté de médecine de Rouen.

CONTEXT: Objective structured clinical examination (OSCE) became a national exam at the end of medical studies in France. The aim of this study was to identify the predictive factors for success at OSCEs. METHODS: Aurvey query after the OSCEs was completed by fifth-year medicine students at Rouen Uuniversity.. Data on continuous variables were compared using the Mann-Whitney test. Data on quantitative variables were compared using the Spearman's correlation. RESULTS: Two hundred and thirty-nine students, i.e., 98.7 % of the students, responded to the query. The median (IQR 25-75) OSCE score was 13.6/20 (12.5-14.2). Students' personal factors significantly associated with a higher OSCE performance were female sex (median score of 13.7 versus 13.4; P=0.03) and good health during the clerkship (median score of 13.6 versus 12.6; P=0.02). A higher OSCE performance was associated with an increased number (≥6)  of medicine clerkships (median score of 13.8 versus 13.3; P=0.02) and a decreased number (<3) of surgery clerkships (median score of 13.7 versus 12.9; P=0.009). There was no correlation between the OSCE score and medical school performance (Spearman's correlation, r=0.24). CONCLUSION: Homogenization of student's clerkships, assistance to students with health problems seem to be teaching approaches to promote success at OSCEs.