Modified Colson flap with subcutaneous liposuction for one-stage donor site removal: A case series.

OBJECTIVES: The aim of this study was to evaluate the functional and cosmetic results of an innovative procedure for modified Colson flap-graft consisting of immediate defatting of the flap by a liposuction cannula. METHODS: A cross-sectional study was performed among patients with deep hand burns requiring a modified Colson flap between 2018 and 2021. Outcomes included functional and cosmetic assessment of the hand through a quality-of-life questionnaire, a sensitivity scale and a scar assessment scale. RESULTS: During this period, 7 patients were operated on using our technique. One patient was lost to follow-up; 7 patients with a median age of 44 years were included, with a total of 10 burned hands. The burns were thermal in 5 out of 7 cases and the coverage concerned the whole hand in 50% of the cases. The flaps all received cannula defatting. The median time to flap weaning was 23 days (20 to 30 days). The median follow-up was 16 months. One case required remote flap weaning. The median POSAS (Patient and Observer Scar Assessment Scale) per patient was 4 and 2 per observer. The median BMRCSS (British Medical Research Council Sensory Scale) was 122. One case had recovered S2 sensitivity, the other cases had S3 or S4 sensitivity. CONCLUSION: Immediate defatting is one of the factors in tegumental quality allowing rapid functional recovery of the hand. The cannula defatting technique does not appear to require additional defatting time. The use of the liposuction cannula allows a one-step, homogeneous, and easier defatting, with a lower risk of devascularization.

Outpatient management of facial fractures in France: Current state.

Maxillofacial trauma is still very common in France with possible involvement of all face bones. Outpatient surgery is an axis strongly put forward by the public authorities. The aim of this study is to establish a current state in the outpatient management of facial fractures in France in 2019 before COVID infection. A closed and semi-open-ended questionnaire was sent to French hospitals treating facial fractures in order to evaluate current and possible future practices in terms of outpatient and perioperative management. Data extracted from the Program for giving Medical significance to Information Systems (PMSI) thanks to the Agency for Information on Hospital Care (ATIH) were also studied to obtain proportions of outpatient care by department. About the questionnaire 43 replies were received. Nasal fractures were the only type of fracture having a minimum average length of stay below 24hours (12.00±16.65) as well as an actual average length of stay (14.22±24.24). Concerning data extracted from the PMSI, 14510 stays were found. Currently only nasal fractures and zygomatic arch fractures requiring simple reduction without osteosynthesis are performed on an outpatient basis. Mandibular fractures could be performed as an outpatient procedure. Access to the operating room and organizational problems specific to each center are factors that limit the development of outpatient management of these facial fractures. Some incompressible parameters such as the monitoring required following the management of these fractures as well as the patients' comorbidities must be taken into account.

[Marjolin ulcers after cultured epidermal autograft in severely burned patients: a rare case series and literature review]. / Marjolin ulcers after cultured epidermal autograft in severely burned patients: a rare case series and literature review.

The advent of tissue engineering and the clinical applications with cultured epidermal autograft (CEA) have improved the prognosis of severely burned patients. Marjolin ulcers (MUs) are a well-known complication of burns. These malignant neoplasm transformations of burn scars are usually squamous cell carcinomas with a higher incidence of regional metastases. Radical surgery remains the treatment of choice. To identify cases of malignant transformation occurring at sites of CEA in a cohort of 68 massively burned patients. A retrospective single-centre study was performed from April 2017 to June 2019 at the Military Hospital of Clamart (France). A total of 34 patients treated between 1991 and 2013 (including one post-mortem) were included. Four cases of squamous cell carcinoma occurred in areas previously covered by CEA. The data from clinical and histopathological examination as well as treatment modalities are presented. One patient died as a result of the evolution of his squamous cell carcinoma, and two others required salvage amputation due to locoregional recurrence. The prevalence of these CEA-MUs is estimated at between 5.9% and 11.7% and the person-time incidence rate of CEA-related MUs is about 5.9 per 1,000 persons-years. In our study, the average time to malignant transformation seems considerably shortened (32-35 years for "classic burn MU" versus 15.7 years for CEA-MU). This first documented case series of CEA-MUs demonstrates the need to inform caregivers and educate patients. Further studies are needed to specify the true incidence of CEA-graft site malignancy.

Burn injury and incidence of psychiatric disorders: A retrospective cohort study of 18,198 patients from Germany.

AIMS: The goal of this study was to investigate the association between burn injury and the incidence of psychiatric disorders in patients followed for up to five years in general practices in Germany. METHODS: This study included patients receiving an initial diagnosis of burn injury in one of 1178 general practices in Germany between 2015 and 2018 (index date). Individuals without burn injury were matched (1:1) to those with burn injury by sex, age, index year, and general practice. For patients without burn injury, the index date was a randomly selected visit date between 2015 and 2018. Study variables included burn injury with body region, psychiatric disorders (i.e. depression, anxiety disorders, reaction to severe stress and adjustment disorders, and somatoform disorders), sex, age, and the Charlson Comorbidity Index. The association between burn injury and the incidence of psychiatric disorders was studied using Kaplan-Meier curves and multivariable Cox regression models. RESULTS: The study included 9099 patients with and 9099 patients without burn injury (53.8% of subjects were women; mean [standard deviation] age was 45.4 [18.5] years). After five years of follow-up, 29.4% of patients with burn injury and 26.2% of those without burn injury were diagnosed with any psychiatric disorder (log-rank p-value < 0.001). Furthermore, there was a positive and significant association between burn injury and the incidence of psychiatric disorders (hazard ratio = 1.32, 95% confidence interval = 1.22-1.43). CONCLUSIONS: Burn injury was positively associated with the incidence of psychiatric disorders in individuals followed for up to five years in general practices in Germany.

Induced membrane technique with sequential internal fixation: use of a reinforced spacer for reconstruction of infected bone defects.

PURPOSE: To evaluate a novel sequential internal fixation strategy using a reinforced spacer for infected bone defect reconstruction by the induced membrane technique (IMT). METHODS: A retrospective case study was performed among patients treated for infected bone defects by applying this strategy. Following radical debridement, temporary stabilization was provided by a massive cement spacer combined with minimal intramedullary fixation during step 1. Definitive internal fixation was performed together with bone grafting at step 2. RESULTS: Eight patients with a mean age of 58 years were reviewed. The mean bone defect length was 8.8 cm. The spacer armature mostly consisted of elastic nails and Steinmann pins. Iterative debridement was required in one case after step 1. The mean interval between steps was 12 weeks. Definitive internal fixation was performed by intramedullary nailing (n = 4) or plating (n = 4). At a mean follow-up of 21 months, bone union was achieved in seven cases without additional bone grafting or infection recurrence. CONCLUSIONS: Sequential internal fixation using a reinforced cement spacer seems to be a valuable option for avoiding external fixation between IMT steps and limiting the recurrence of infection.

[Acute inpatient treatment of severe burns]. / Prise en charge hospitalière des brûlures graves.

Acute inpatient treatment of severe burns. Acute in-hospital care of severely burned patients intricately combines surgery and intensive care. Systemic and supportive care is centered on hemodynamic management of the initial plasmorrhagic shock, airway control, enteral nutrition in order to compensate for hypercatabolism, analgesia and adjuncts. Infection is a major risk, to be prevented and managed topically. Sytemic administration of antibiotics is limited to documented sepsis. Smoke inhalation injury is diagnosed by fiberoptic bronchoscopy and managed with protective ventilation, iterative bronchoscopic cleansing, and nebulized heparin, mucolytics and bronchodilators. Emergent surgery in the burned patient includes initial treatment of associated trauma, escharrotomies, and fasciotomies in selected cases. Acute surgery is centered on early excision and skin autografts to restore cutaneous integrity. Reconstructive surgery is delayed.

Prise en charge hospitalière des brûlures graves. Le traitement hospitalier aigu des brûlés graves associe étroitement chirurgie et réanimation. Le traitement général est centré sur la gestion hémodynamique du choc plasmorragique initial, le contrôle des voies aériennes, la nutrition entérale pour compenser l'hypercatabolisme, l'analgésie-sédation, et la suppléance des défaillances. L'infection, risque majeur, est prévenue et traitée par voie locale en priorité : l'antibiothérapie systémique est réservée aux sepsis documentés. L'inhalation de fumées, de diagnostic fibroscopique, est traitée par ventilation protectrice, toilettes bronchiques itératives, et aérosols d'héparine, mucolytique et bronchodilatateur. La chirurgie du brûlé comprend, en urgence, le traitement prioritaire des traumatismes associés, les escarrotomies de décharge, voire les fasciotomies ; en phase aiguë, la restitution de l'intégrité cutanée par des excisions et autogreffes précoces ; à distance, la chirurgie réparatrice des séquelles.