In vitro effects of wound-dressings on key wound healing properties of dermal fibroblasts.

Healing of complex wounds requires dressings that must, at least, not hinder and should ideally promote the activity of key healing cells, in particular fibroblasts. This in vitro study assessed the effects of three wound-dressings (a pure Ca2+ alginate: Algostéril®, a Ca2+ alginate + carboxymethylcellulose: Biatain alginate® and a polyacrylate impregnated with lipido-colloid matrix: UrgoClean®) on dermal fibroblast activity. The results showed the pure calcium alginate to be non-cytotoxic, whereas the other wound-dressings showed moderate to strong cytotoxicity. The two alginates stimulated fibroblast migration and proliferation, whereas the polyacrylate altered migration and had no effect on proliferation. The pure Ca2+ alginate significantly increased the TGF-ß-induced fibroblast activation, which is essential to healing. This activation was confirmed by a significant increase in Vascular endothelial growth factor (VEGF) secretion and a higher collagen production. The other dressings reduced these fibroblast activities. The pure Ca2+ alginate was also able to counteract the inhibitory effect of NK cell supernatants on fibroblast migration. These in vitro results demonstrate that tested wound-dressings are not equivalent for fibroblast activation. Only Algostéril was found to promote all the fibroblast activities tested, which could contribute to its healing efficacy demonstrated in the clinic.

Dermal substitute: a safe and effective way in surgical management of adults post-burn dorsal foot contractures.

OBJECTIVE: Neglected dorsal foοt burns may result in typical fοrefοοt defοrmities characterised by cοntractures leading tο hyperextensiοn οf the tοes and gait disturbance. These defοrmities usually cause a significant impairment in daily activities and difficulty in wearing shοes. This article presents a recοnstructiοn series οf severe fοrefοοt defοrmities by means of dermal regeneratiοn templates (also known as dermal substitutes) and split thickness skin grafts. PATIENTS AND METHODS: We retrοspectively reviewed οur institutiοnal burn database from 2010 to 2020 focusing on all those dοrsal fοοt cοntractures treated with the use οf a dermal regeneratiοn template. The patients' demοgraphics, burn injury mechanisms, depth, lοcalizatiοn, surface, treatments and fοllοw-up were described. RESULTS: Twelve patients underwent this prοcedure and the mean affected area was 75 cm2. The mean time between the dermal regeneratiοn template applicatiοn and the split thickness skin graft was 19.6 days. Just fοr one patient, an additiοnal skin grafting prοcedure was required. The mean fοllοw-up was 4.6 years. We did not register specific cοmplicatiοns at bοth the recipient (forefoot) and dοnοr sites (scalp). All patients were able tο wear shοes and walk after the procedure. Nο recurrence οf cοntractures were οbserved. All patients were satisfied with cοsmetic results, and they did not request any additiοnal prοcedure οf cοsmetic imprοvement. CONCLUSIONS: The use οf the dermal regeneratiοn template can be cοnsidered as an extremely safe and efficient treatment οf severe post-burn fοrefοοt defοrmities.

Repair Of Palm Burns Of The Hand: A Contralateral Inner Arm Bag-Shaped Flap.

Hands are one of the most often burnt parts of the body. Deep palmar burns are often the result of an electrical burn or a thermal burn from grasping a hot item. With a deep burn, joints, vasculo-nervous pedicles, tendons or bones can become exposed and lead to amputation. Different surgical repair methods are used depending on the area of the hand that is burnt. Most of the publications to date have described surgical techniques for dorsal hand burns. The abdominal bag-shaped flap is one of the main surgical techniques to cover dorsal deep tissue exposure. Bag-shaped flaps need time to achieve the vascular autonomy of the flap without any movement. Abdominal bagshaped flaps are particularly suitable for dorsal soft-tissue defects, while for palmar defects, it is an uncomfortable position to maintain for three weeks. A contralateral arm bag-shaped flap for palmar burns allows a comfortable position to be achieved as the upper burnt limb is positioned as if the patient has their arms crossed. Furthermore, as stated above, the contralateral arm bag-shaped flap has the advantage of allowing a flap to be used that is thinner than an abdominal bag-shaped flap. At the Saint Louis Burns Center, we recently treated two patients with deep palmar burns and deep tissue exposure. We performed a contralateral arm bag-shaped flap for both of these patients. In our experience, the use of the contralateral arm bag-shaped flap technique to cover palmar lesions resulted in favorable postoperative progression, with complete closure of the lesions, good functional outcomes, as well as other advantages such as a hidden scar at the donor site. This technique allows amputation of fingers to be avoided when pedicles, joints, or tendons are exposed and when the burnt area of the palm is extensive and no other flaps can be used.

Les brûlures surviennent fréquemment au niveau des mains. Les brûlures profondes de la face palmaire des mains sont souvent secondaires à des brûlures électriques ou à des contacts sur des solides chauds. À la suite d'une brûlure profonde, les articulations, les pédicules vasculonerveux, les tendons ou les os peuvent être exposés, conduisant à des indications d'amputation. Différentes techniques de chirurgie réparatrice peuvent être utilisées, en fonction de la zone anatomique brûlée. La plupart des publications décrivent des techniques de couverture des brûlures de la face dorsale de la main. Le lambeau d'empochement abdominal est l'une des principales techniques décrites pour la couverture des pertes de substance profondes de la face dorsale de la main. Ces lambeaux d'empochement nécessitent une immobilisation stricte pour permettre une revascularisation anatomique du lambeau. Si ces lambeaux d'empochement abdominaux sont une très bonne indication pour les pertes de substance de la face dorsale de la main, la position est particulièrement inconfortable à maintenir trois semaines pour les faces palmaires. Un lambeau d'empochement à la face interne du bras controlatéral pour les brûlures palmaires de la main permet de maintenir une position confortable, comme si le patient avait les bras croisés. De plus, le lambeau d'empochement sur la face interne du bras controlatéral a l'avantage de fournir un lambeau plus fin que le lambeau d'empochement abdominal. Au centre de brûlés de Saint-Louis, nous avons récemment traité deux patients présentant des brûlures profondes de la face palmaire de la main et avec exposition de tissus nobles. Nous avons réalisé un lambeau d'empochement du bras controlatéral pour chacun de ces patients. Dans notre expérience, cette technique d'empochement des lésions palmaires a permis une couverture complète, de bons résultats fonctionnels et, a l'avantage que la cicatrice du site donneur est peu visible. Cette technique permet d'éviter des amputations digitales en cas d'exposition articulaire, tendineuse ou pédiculaire lorsque la surface palmaire brûlée ne permet pas l'utilisation d'autres lambeaux.

Head and neck skin expansion: assessment of efficiency for the treatment of lesions in the lower half of the face.

The treatment of sequelae for burns or other loss of perioral tissues is complex due to the site where they occur, its functional importance, and social and esthetic aspects. Functional consequences of burns to this area are cutaneous retraction and a lack of skin that can lead to an inability to close the oral aperture, compromising the provision of dental hygiene and intubation procedures. The aim of the present publication was to evaluate the efficacy of chin, labial and jugal cutaneous expansions for the treatment of perioral lesions and lesions of the lower half of the face in our retrospective series of patients. We collected data and photography from digital files for each patient. Proportion of scarred skin that could be treated by one or several expansion procedures was evaluated. The main outcome was the resection of 50% or more initial lesions. Side effects were assessed. Out of a total of 33 expanders, 28 were at the jugal level, 5 were chin expanders, and none were labial expanders. This equated to the inclusion of fourteen patients. The average percentage of the lesion that was removed after the perioral expansion protocol was 68.9% (40%-100%). 85% of patients had a positive outcome. 12% of procedures were complicated by hematoma, infection or prosthesis exposure. Each time that the lesional area could be fully (i.e. 100%) treated, only a single expansion was used. Head and neck expansion is the technique of choice for reconstruction of the lower half of the face and the horizontal part of the neck in terms of efficiency and safety.

Le traitement des séquelles de brûlures ou d'autres pertes de substances tissulaires de la région péri buccale est complexe du fait de l'importance fonctionnelle de cette région et des conséquences esthétiques et sociales. Les conséquences des brûlures de cette région sont les rétractions ou la rigidité cutanées entrainant une limitation de la fermeture buccale et de ce fait compromettant l'état dentaire et les procédures d'intubation. Le but de ce travail est d'évaluer l'efficacité de l'expansion cutanée du menton, des lèvres et des joues dans le traitement des lésions de la région péribuccale ou de la face basse par une étude rétrospective de notre série. Nous avons repris les données cliniques et les photographies à partir des dossiers informatisés pour chaque patient. Nous avons évalué la quantité de peau cicatricielle traitée en un ou plusieurs temps. Le résultat principal est que plus de 50% de la lésion initiale a été traitée. Les effets secondaires ont été évalués. 14 patients ont été inclus. 33 expandeurs ont été posés, 28 étaient au niveau de la joue, 5 sur le menton et aucun sur les lèvres. Le pourcentage moyen de lésion excisée après expansion cutanée de la région péribuccale était de 68,9% (40%-100%). 85% des patients ont eu un résultat satisfaisant. 12% des procédures d'expansion se sont compliquées d'hématome, d'infection ou d'exposition de la prothèse. A chaque fois que la lésion pouvait être traitée totalement, une seule procédure a été réalisée. L'expansion cutanée de la tête et du cou est la technique de choix pour la reconstruction de la face basse et de la portion horizontale du cou en termes de résultats et de complications.

Reconstruction Of The Burnt Nose Using A Carved Flap In Four Cases.

Techniques for reconstructing nasal defects in burns are very limited because the surrounding scar tissue makes it difficult to use local flaps. The authors report their experience using the Converse scalping flap harvested from scarred skin, placed as a mass on the nasal area, then secondarily carved to shape the nose and covered by a skin graft. This is a retrospective study of 4 patients, 3 men and 1 woman, with an average age of 45 years, who were operated on between 1994 and 2013 using this technique for postburn nasal reconstruction. Patients had 45% burns on average. The flap was weaned from its donor site at the third week and the frontalis donor area grafted. Several months later, the flap was sculpted from the outside to the inside in the three dimensions, removing the scarred epidermal areas to restore the aesthetic units of the nose, which were grafted using a full thickness skin graft. The final aesthetic result of the nasal reconstruction was evaluated by the patient and the surgical team. The four nasal reconstructions were carried out to completion. Three were rated as 'very good' (75%) and one was rated as 'good' (25%). The Converse flap modification, referred to as the "carved flap", to reconstruct the burned nose is a reliable technique, possible on a scarred forehead with no additional donor site morbidity.

Les techniques de reconstruction nasale après brûlure sont limitées. En effet, la peau cicatricielle environnante rend difficile l'utilisation de lambeaux locaux. Les auteurs rapportent leur expérience avec le lambeau scalpant de Converse prélevé en peau cicatricielle, placé en bloc sur la région nasale puis secondairement sculpté pour donner sa forme au nez et greffé. Il s'agit d'une étude rétrospective sur quatre cas, 3 hommes et 1 femme, d'un âge moyen de 45 ans, opéré entre 1994 et 2013, en utilisant cette technique de reconstruction nasale après brûlure. Les patients étaient brûlés en moyenne à 45% de la surface corporelle. Le lambeau a été sevré du site donneur à trois semaines et la perte de substance au niveau du front a été greffée. Plusieurs mois plus tard, le lambeau a été sculpté de dehors en dedans dans les trois dimensions, la peau cicatricielle a été désépidermisée sur l'unité esthétique du nez qui a été greffée en peau totale. Le résultat esthétique final de cette reconstruction nasale a été évaluée à la fois par le patient et par l'équipe chirurgicale. Les quatre reconstructions nasales ont été menées à terme. Elles ont été cotées comme très bon résultat dans 75% des cas et comme bon résultat dans 25% des cas. Ce lambeau de Converse modifié, appelé « lambeau sculpté ¼, est une technique fiable pour reconstruire un nez, possible sur un front cicatriciel et sans morbidité additionnelle au site donneur.

Electrical Burns and Late Spontaneous Artery Ruptures: About Three Cases.

Electrical burns are responsible for arterial and venous thrombosis, as well as weakening of the arteries. Immediate or delayed arterial occlusions, secondary to the aggression of the intima, or aneurysms, secondary to the aggression of the media, sometimes lead to artery ruptures without any warning signs. Such ruptures may trigger a hemorrhagic shock whose period of onset is variable and unpredictable. We are presenting here three cases treated in our department for electrical burns, whose complications were marked by hemorrhagic shock, secondary to late artery ruptures, sometimes occurring several months following the event. These case reports required performance of emergency hemostasis in order to control sudden bleeding, with first approach being placement of a tourniquet at the base of the limb and/or a compression point. Through these cases, we thought it is crucial to closely monitor for a few weeks all patients who were victims of electrical injury, even more so if it was associated with a compartment syndrome of one or more limbs and high rhabdomyolysis, which seem to be predictive factors of late artery ruptures in our case reports.

Brûlures chimiques: notre série sur 25 ans.

Chemical burns raise diagnostic and treatment issues because they have specific appearances and evolution. Our objective was to study the characteristics of chemical burns and to assess the quality of our treatment. This retrospective observational study examined the records of all patients admitted for chemical burns to the burn treatment center of Saint Louis Hospital in Paris from January 1, 1990, through December 31, 2015. During this period, 162 patients came to our center for chemical burn treatment. Most of them were men (67%). The majority of the burns were caused by alkalis (27%) and resulted from workplace accidents (29%). The average time before consultation was 5.36 days. The areas mainly damaged were the hands (36%) and the burn areas averaged 1.2% of the total body surface area (TBSA). Forty-eight patients had at least one deep patch. In total, 59 patients (36.4%) were hospitalized for an average duration of 4.18 days. Thirty-eight of them underwent surgery. Lastly, 92% of the operations had been anticipated from the first consultation. In our center, the population affected, the circumstances and the topography of our patients' burns were similar to the data from the literature. It appears that the principal specificity of our series is a very low body surface burned. This can be attributed to the prevention measures we have in France and underlines their importance. Only 8% of the patients who had surgery were underestimated or their burns became deeper secondarily. This number is lower than the data from other series.

[Greater omentum flap: Treatment of chronic wounds and seroma: About a case]. / Le lambeau de grand épiploon : traitement des plaies et lymphorrhees chroniques : à propos d'un cas.

INTRODUCTION: Cicatricial complications after abdominal or pelvic surgery are more frequent in obese patients. In this case, infection, seroma and delays in scarring can be extremely difficult to treat. The objective of this technical note is to present an original case of an obese patient operated nine years ago of a hysterectomy by laparotomy and chronically presenting a non-resolving septic seroma despite multiple surgical procedures whose healing could be obtained by a flap of greater omentum. SURGICAL TECHNIQUE: The ideal is to carry out this intervention in a double team with a digestive surgeon in case of intra-abdominal visceral or vascular wound during dissection. The greater omentum flap was raised in a conventional manner over the gastroepiploic artery. A sufficiently wide orifice should be left at the level of the abdominal aponeurosis in order to avoid any compression of the pedicle. Finally, the flap must be spread over the whole surface of the detachment and fixed to the anterior aponeurosis. CONCLUSION: Reliability and vascular and lymphatic richness make the greater omentum flap a very effective method in chronic wound cases associated with important seroma. The scarring obtained in the clinical case presented thus highlights the specific qualities of this flap.

Our 35 years' experience on postburn heterotopic ossification: A three-step treatment.

Our retrospective study of burn patients presents a three-step treatment of heterotopic ossification: excision surgery, early rehabilitation, and analgesia. We included patients admitted to the department for treatment of postburn heterotopic ossification between January 1, 1979, and September 30, 2015. The mean age at the time of the burn was 43.3 years. Men accounted for the majority of burn patients who developed an osteoma (70.8%). The mean total skin area burned was 38.4%. No osteoma justifying surgery was found for any patient with a total burned skin area less than 19%. The burned zones were related to the osteoma development in 94.3% of cases. On average, the surgery took place 10.8 months after the burn. The osteotomy was accompanied by surgical treatment of a contracture in 37.1% of patients. Most of the osteomata were found at the elbows (30), followed by the shoulders (3), and finally the knees (2). Rehabilitation began on D0 after the surgery, except if a flap or a thin-skin graft was used. Regarding analgesia, opiates were prescribed systematically during the immediate postoperative period. Elbow range of motion on flexion improved by a mean of 84.1°. During the postoperative period, we found 2 recurrences of osteoma and 1 elbow hematoma in two separate patients. There were no postoperative infections or neurological sequelae. Our retrospective French study confirmed results found in the international literature. The three-step treatment - excision surgery, early rehabilitation, and antalgia - seems to be the best means of treating osteoma with satisfactory results. Surgery is indicated only in the case of functional impairment and not simply based on imaging.

[Self-inflicted burns in our burns center between 2011 and 2016]. / Immolation dans notre centre de traitement des brûlés de 2011 à 2016.

The prevalence of immolation by fire in France is uncertain. We carried out a retrospective epidemiological study on immolations between 2011 and 2016 at the burn treatment centre at the hôpital Saint-Louis in Paris. We studied the prevalence and characteristics of patients entering hospital for this reason. Between 2011 and 2016, a total of 1098 patients were hospitalized in the centre, of which 50 were admitted for immolation, i.e. five percent of the hospitalized population. The average age at entry was 46 years, and they were mostly men (62%). All but one was a suicide attempt. The average total burn area was 34.5%, and the average length of stay in the centre was 53 days. The products used for the immolation were mostly white spirit, alcohol or gasoline. Nine (18%) out of the 50 patients died, burned at 62.5% on average. A psychiatric history was reported in 35 patients and 21 had previously attempted suicide; nine patients were chronic alcoholics and four were drug addicts. The most frequently reported reasons for the suicide attempt were sentimental breakdown, death of a relative or financial problem. The prevalence of immolation in our study is very low compared to that found in developing countries. The majority of our cohort is composed of patients with a history of psychiatric disorders. The history of attempted suicide is also a major risk factor for committing suicidal acts by immolation. Prevention measures should be implemented to reduce this risk.

[Reconstruction of abdo-perineal resection by Taylor flap: About 68 patients]. / Reconstruction par lambeau de Taylor après amputation abdomino-périnéale : à propos de 68 cas.

PURPOSES: Healing after abdomino-perineal resection is often difficult, especially in patients who have undergone radiation therapy. Vaginal reconstruction is also an important issue for the women who undergo this surgery. We describe and analyze here our series of perineal reconstructions with modified Taylor flaps. Between 2010 and 2016, 68 patients (52 women, 16 men) with cancer of the anal canal (53), adenocarcinoma of the lower rectum (9), or other malignant neoplasms of the perineum underwent reconstruction with a rectus abdominis myocutaneous (RAM) flap with an inferior pedicle and an oblique skin paddle. RESULTS: This review of records showed that all patients healed, with a median of 30 days. The reoperation rate was 11.7% including 1 for eventration. The principal causes for delayed healing were scar dehiscence, abscess, and partial necrosis. No flap required removal, however. The mean duration of hospitalization was 23.7 days. CONCLUSION: Modified Taylor flaps substantially improved the reconstruction of defects resulting from abdomino-perineal resection. They enabled complete and rapid healing with low comorbidity.

[Management of hypopigmented scars following burn injuries]. / Prise en charge des cicatrices hypopigmentées post-brûlure.

OBJECTIVE: Permanent hypopigmentation of burn scars is a common consequence after partial and full thickness burns that heal by secondary intent, and they can cause severe aesthetic issues. The surgical goals for effective treatment of postburn hypopigmentation are to remove scar tissues, and to produce healthy melanocytes, with minimal donor site morbidity. This article reviews the current literature about the different ways to treat hypopigmentation following burn injuries and discusses the indications. METHODS: The PubMed database was searched for articles published from 1985 and up to 2016. Papers with regards to the management of hypopigmented lesions were included only if scars were following burn injuries. The treatments were assessed according to body region treated, surface involved, skin color, effectiveness on restoring skin pigmentation. RESULTS: Sixteen studies were included in this review. Non-surgical treatments like makeup and tattooing, and surgical treatments including thin skin grafting, chip skin grafting, punch grafting, non-cultured keratinocyte-melanocyte cell suspension, and cultured epidermal cells were all compared. CONCLUSION: Thin skin grafting is a reliable treatment especially for patient who suffer from small hypopigmented lesions as this method requires a donor skin of the same size. The cell suspension procedure may be beneficial for larger scars. Moreover demarcation between skin graft and normal skin may exist and when a precise color match is required, particularly in the head, tattooing and chip skin grafting produce a good pigmentation outcome.

[Study of satisfaction concerning the navel after abdominal dermolipectomy with transposition: A report of 96 cases]. / Ombilicoplastie en aile de mouette : technique et satisfaction ; à propos de 96 cas.

GOAL OF THE STUDY: The umbilicus has a major role in the aesthetics of the anterior abdominal wall. Many publications deal with abdominal dermolipectomies but few focus on umbilicoplasty. However, these are essential in assessing the aesthetic result. Umbilicoplasty in "aile de mouette" used in our service is reliable and easily reproducible. In this article, we evaluate the satisfaction of patients with abdominal dermolipectomy with this technique of transposition. MATERIALS AND METHOD: In the plastic surgery department of the Saint-Louis Hospital in Paris, we carried out a retrospective study of patients undergoing abdominal dermolipectomy with transposition of the umbilicus, between 1 January 2012 and 31 December 2012. All patients were operated according to our technique of umbilicoplasty: disinsertion of the umbilicus in V, reinsertion of the umbilic in "aile de mouette", a degreasing periumbilical associated with a plication of the umbilical stem. The complications identified in patients medical records and satisfaction were assessed by a telephone questionnaire. RESULTS: Ninety-six patients were included. No patient presented umbilical necrosis. The overall result of umbilical transposition was considered good to excellent for 92.7% of patients. CONCLUSION: Umbilicoplasty in gull wing has many advantages: it is a simple, easily reproducible, reliable technique, the patients of which are for the most part very satisfied.

Burns caused by electronic vaping devices (e-cigarettes): A new classification proposal based on mechanisms.

Introduction With more than 10 million of daily users, e-cigarettes encountered a great success. But in the past few years, the number of medical reports of injuries caused by the explosion of e-cigarettes has significantly increased. This article aims at reporting our series and reviewing the literature to propose a new classification based on the mechanisms of injuries related to e-cigarettes that can guide non-specialists and specialists in the management of these patients. Method We performed a retrospective review of our institutional burn database from June 2016 to July 2017 for injuries caused by or in the context of using an e-cigarette. The patients' demographics (age, gender), burn injury mechanisms, depth, localization, surface and interventions were described. Results Ten patients suffered from burns related to the use of e-cigarettes. The burns were located at the thigh (80%) and the hand (50%) with a mean surface of 3% of TBSA. Four different mechanisms could be described: Type A: thermal burns with flames due to the phenomenon of "thermal runaway", Type B: blasts lesions secondary to the explosion, Type C: chemical alkali burns caused by spreading of the electrolyte solution and Type D: thermal burns without flames due to overheating. These different mechanisms suggest specific surgical and non-surgical management. Conclusion Management of injuries sustained from e-cigarettes' explosions should be approached from the standpoint of mechanisms. Different mechanisms could be associated and should be considered in specific management.

Pressure guided surgery of compartment syndrome of the limbs in burn patients.

Compartment syndrome is a serious complication of high voltage electrical burns, limb carbonization and deep circular burns with delayed escharotomy. Without treatment, ischemic tissue damage leads to irreversible necrosis. Treatment is emergency surgical decompression. The burned patient is usually not searchable and cannot always be readily examined because of bulky dressings; diagnosis of compartment syndrome is always hard to make. The pressure transducer used in central arterial catheters is easy available. We used it to measure pressure in muscular compartments. We measured compartment pressure three times at different depths in all cases of electrical burn, carbonization and deep circumferential burns with delayed escharotomy. We also took the pressure in the uninjured limb. The pressure assessment device was composed of a blood pressure transducer commonly used in arterial catheters for arterial pressure monitoring with three connecting branches. The first branch was connected to the 'arterial pressure exit' in the monitoring device. The second, an IV tube, was connected to one litre of physiological serum in a pressure bag inflated to 200 mmHg. The third, also an IV tube with a sterile extension cable, was directly connected to an 18G standard straight needle to be inserted in the tissues for which interstitial pressure had to be measured. In patients with thermal burns, we measured pressure before and after escharotomy. Threshold intracompartmental pressure was 35 mmHg. We carried out pressure assessment of all muscular compartments during and at the end of surgery. The pressure transducer provides a pressure value in all muscular compartments with a time of installation and measuring of less than 5 minutes. Sensitivity is measured at +/- 1 mmHg. Operation is simple, non-operator dependent, and accessible to medical and paramedic teams. The pressure transducer allows accurate diagnosis of early or established compartment syndrome. It requires no additional equipment and its application does not delay therapeutic management. Its use helps with fasciotomy decision, especially after escharotomy, guides the surgeon in the exploration of different compartments and verifies the effectiveness of surgery.

Le syndrome de loge est une complication sévère des brûlures électriques de haut voltage, les carbonisations de membres et les brûlures profondes circulaires en attente d'escarrotomie. Sans traitement, les lésions tissulaires ischémiques apparaissent et entrainent des lésions nécrotiques irréversibles. Le traitement est la décompression chirurgicale d'urgence. Le brûlé est généralement in interrogeable et le diagnostic est toujours difficile à établir étant donné les volumineux pansements. Le capteur de pression au moyen de cathéters artériels est facile et nous l'utilisons pour mesurer la pression dans les loges musculaires. Nous mesurons cette pression compartimentale à 3 reprises à des profondeurs différentes, dans tous les cas de brûlures électriques avec carbonisation et brûlures circonférentielles profondes et qui sont en attente d'escarrotomie: nous prenons également la pression au niveau des membres non atteints. L'appareil de mesure est composé d'un capteur de pression sanguine, avec trois connexions: la première est la pression artérielle habituelle, la deuxième est en rapport avec 1 litre de sérum dans une poche gonflée à 200 mm Hg, la troisième est directement en rapport avec une aiguille 18 G pour être insérée au niveau des loges musculaires. Chez les patients porteurs de brûlures thermiques, la pression est prise avant et après l'escarrotomie. Le niveau de pression intra compartimentale est de 35 mm d'Hg. Nous évaluons la pression dans toutes les loges pendant la chirurgie et à la fin de l'intervention. Le capteur permet d'évaluer la pression dans tous les compartiments musculaires en moins de cinq minutes, avec un degré de fiabilité de plus ou moins 1mm Hg. L'opération est simple, non opérateur dépendant et accessible aux médecins et aux paramédicaux. Le capteur de pression permet le diagnostic précoce du syndrome de loge. Il ne nécessite pas un équipement additionnel et son usage ne retarde pas le début de la thérapeutique. Il aide à la décision de fasciotomie, spécialement après escarrotomie, guide le chirurgien dans l'exploration des différentes loges et vérifie l'efficacité de la chirurgie.