[Serious burns associated with a fracture : how to react in emergency]. / Comment je traite en urgence des brûlures graves associées à une fracture.

The incidence of burns associated with one or even several fractures is rare and linked to high-energy mechanisms (traffic accidents, terrorist attacks, etc.). Treatment requires a multidisciplinary approach both at the medical and paramedical levels. The various stages of treatment require a systematic reassessment of the situation according to the patient's evolution. Detailed understanding of treatment strategies and outcomes is vital when managing these patients with multiple trauma. We will discuss about our experience with a focus on the management of burns, fractures and associated pathologies.

L'incidence des brûlures associées à une ou plusieurs fractures est rare et liée à des mécanismes à haute énergie (accidents de roulage, attentats…). La prise en charge nécessite une approche pluridisciplinaire tant au niveau médical que paramédical. Les diverses étapes de traitement nécessitent une réévaluation systématique de la situation en fonction de l'évolution du patient. La compréhension détaillée des stratégies de traitement et des résultats est vitale lors de la prise en charge de ces patients polytraumatisés. Nous allons discuter de notre expérience avec un focus sur la prise en charge des brûlures, des fractures et des pathologies associées.

An innovative 3D hydroxyapatite patient-specific implant for maxillofacial bone reconstruction: A case series of 13 patients.

The study aimed to evaluate and discuss the use of an innovative PSI made of porous hydroxyapatite, with interconnected porosity promoting osteointegration, called MyBone Custom® implant (MBCI), for maxillofacial bone reconstruction. A multicentric cohort of 13 patients underwent maxillofacial bone reconstruction surgery using MBCIs for various applications, from genioplasty to orbital floor reconstruction, including zygomatic and mandibular bone reconstruction, both for segmental defects and bone augmentation. The mean follow-up period was 9 months (1-22 months). No infections, displacements, or postoperative fractures were reported. Perioperative modifications of the MBCIs were possible when necessary. Additionally, surgeons reported significant time saved during surgery. For patients with postoperative CT scans, osteointegration signs were visible at the 6-month postoperative follow-up control, and continuous osteointegration was observed after 1 year. The advantages and disadvantages compared with current techniques used are discussed. MBCIs offer new bone reconstruction possibilities with long-term perspectives, while precluding the drawbacks of titanium and PEEK. The low level of postoperative complications associated with the high osteointegration potential of MBCIs paves the way to more extensive use of this new hydroxyapatite PSI in maxillofacial bone reconstruction.

Female-to-Male Chest Surgery in Transgender Patients: A Comparison Between 2 Different Techniques and a Satisfaction Study in a Single Center.

Background: Gender dysphoria is a distress caused by a mismatch between gender identity and the sex assigned at birth. About 0.5% of the population suffer from gender dysphoria, which represents 25 million people worldwide. Gender-affirming mastectomy is the most common procedure for female-to-male patients. Objectives: The aim of this single-center retrospective study is to present the outcomes after mastectomy and to evaluate patient satisfaction using the BODY-Q questionnaire. Methods: Several data regarding patient characteristics and surgery have been collected. A satisfaction survey has been sent to patients. Two groups, "NAC grafts" and "semicircular," have been compared for complications and satisfaction. Results: A total of 103 patients have had a transgender mastectomy performed by 3 surgeons, representing 206 mastectomies. There were 5 wound infections (4.8%), 8 seromas (6.8%), 10 hematomas (6.8%), and 23 partial/total nipple areolar complex (NAC) necrosis (20.4%). The complication rates in this study are similar to others in the literature. Few studies express interest in patient satisfaction after this type of surgery and even fewer use a suitable questionnaire. Conclusions: Transgender mastectomy is a safe and often necessary procedure to improve the quality of life of patients suffering from gender dysphoria. Nevertheless, there is currently no validated tool to assess postoperative satisfaction within this specific population group.

[How I treat pediatric burn management in emergency department]. / Comment je traite la brûlure de l'enfant aux urgences.

Acute management in emergency department of pediatric burns is challenging for clinicians. Many of these burns are minor and can be treated on an outpatient basis. However, moderate and severe burns require hospitalization. Although management principles are similar between children and adults polytrauma, children have differences in their pathophysiological response to burn injury. Understanding these differences is essential to optimize the patient care. Particularities of acute management of pediatric burns are discussed in this article.

La prise en charge aux urgences d'un enfant brûlé est un défi pour les cliniciens. Souvent superficielles, la plupart des brûlures peuvent être traitées en ambulatoire. Cependant, les brûlures modérées et sévères nécessitent une hospitalisation. Bien que la prise en charge repose sur des principes similaires à ceux des patients polytraumatisés, les enfants présentent des différences dans la réponse physiopathologique à la brûlure. Tenir compte de ces différences est essentiel pour une prise en charge optimale. Les spécificités des modalités thérapeutiques urgentes lors de brûlures chez l'enfant sont discutées dans cet article.

Description of Two Cases of Anaplastic Large Cell Lymphoma Associated with a Breast Implant.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized provisional entity in the 2017 revision of the World Health Organization classification of lymphoid neoplasms. Although the majority of the cases described in the literature demonstrate an effusion confined to the capsule of the breast implant, this rare pathology can also invade the capsule and adjacent tissues and/or involve lymph nodes. We hereby report two new cases of BIA-ALCL in a 58-year-old and a 47-year-old Caucasian female who received a silicone breast implant. The first patient showed a sudden and rapid right breast volume increase 6 years after the implantation surgery. As for the second patient, a left breast volume increase was observed also suddenly and quickly 11 years after surgery. In both cases, an uncompressed mammography was performed allowing a new approach to highlight periprosthetic fluid reaction. Pathologic examination of the fluid collection revealed atypical cells positive for CD30 and CD45 and negative for ALK and CK7. This allowed pathologists to diagnose a breast implant-associated anaplastic large cell lymphoma. Patients were treated with bilateral capsulectomy with no additional local or systemic therapy. The development of breast augmentation may come with an increase in the frequency of this pathology. Radiologists and senologists must therefore be careful when women with breast implants show an increase of breast volume and all cases of BIA-ALCL must be recorded and reported.

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

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

Laddering melanotic pattern of Langer's lines in skin of colour.

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

Liposuction in benign symmetric lipomatosis: sense or senseless?

Benign symmetric lipomatosis is a rare form of typical fat distribution in the shoulders, the arms, and the neck that can compromise the respiratory, nutritional, and psychological status of the patient. Alcoholism, malignant tumors of the upper airways, endocrine tumors, hypothyroidism, diabetes, and hypertriglyceridemia are often associated with its occurrence. Surgical removal via lipectomy or liposuction can give good cosmetic results, although recurrences often occur. Liposuction has become the first choice to treat this disorder in patients with smaller masses. We have operated on four such cases in which liposuction failed and surgical excision had to be performed. We present a summary of the clinical characteristics of all four patients and discuss the different treatment options.