RESUMEN
BACKGROUND: Breast reduction surgery often concern women of childbearing age. However, it can interfere with the ability to breastfeed, whereas the benefits of breastfeeding are well known. Current data in the literature do not provide precise information on the possibilities of breastfeeding after breast reduction surgery. OBJECTIVES: The aim of this study was to assess long-term breastfeeding ability of women after breast reduction performed in our centre. METHODS: This is a retrospective comparative study including patients treated with breast reduction at Saint-Louis Hospital between 2010 and 2017 and who have had children before or after surgery. Operative details were retrieved from medical records and ability to breastfeed was assessed during a phone interview. Breastfeeding before surgery was compared to breastfeeding after surgery. RESULTS: We analysed 21 births before and 35 births after breast reduction. Breastfeeding initiation was similar in the two groups (90% vs. 83%, P=0.7), but the median duration was significantly shorter after breast reduction compared with before (3 weeks vs. 10 weeks; P<0.01), the rate of breastfed child at 3 months was lower after surgery (11% vs. 43%; P<0.01), the use of infant formula was higher after surgery (100% vs. 74%, P<0.01), and we found a higher rate of discontinuation caused by hypogalactia (69% vs. 11%; P<0.001). CONCLUSION: Breastfeeding is possible but more difficult to sustain over time after breast reduction. Patients need to be made aware of that before surgery, and patients who still want to breastfeed should be encouraged at the maternity.
Asunto(s)
Lactancia Materna , Mamoplastia , Humanos , Femenino , Estudios Retrospectivos , Adulto , Factores de TiempoRESUMEN
BACKGROUND: Reconstruction of nasal defects is a challenging task due to the complex nasal geometry and the need for aesthetic considerations. The bilobe flap has emerged as a reliable technique for nasal reconstruction, particularly for defects involving the nasal tip, alae, and inferior dorsum. OBJECTIVE: This study presents a review of 31 patients who underwent bilobe flap reconstruction for nasal defects after tumor resection. MATERIALS AND METHODS: The surgical technique, short- and long-term aesthetic outcomes, patient satisfaction, and complications were evaluated. Aesthetic outcomes were assessed using a qualitative ordinal scale, and long-term patient satisfaction was obtained through follow-up notes and phone interviews. RESULTS: Bilobe flap reconstruction yielded good aesthetic outcomes in the majority of cases, with high patient satisfaction. Complications were minimal, and revision surgeries were performed in a small number of cases to address aesthetic concerns. CONCLUSION: Overall, the bilobe flap technique proved to be an effective and reliable option for nasal reconstruction, providing stable and long-lasting results.
Asunto(s)
Neoplasias Nasales , Satisfacción del Paciente , Rinoplastia , Colgajos Quirúrgicos , Humanos , Estudios Retrospectivos , Rinoplastia/métodos , Femenino , Masculino , Persona de Mediana Edad , Estudios de Seguimiento , Anciano , Neoplasias Nasales/cirugía , Adulto , Estética , Anciano de 80 o más Años , Nariz/cirugía , Nariz/anomalías , Factores de TiempoRESUMEN
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.
Asunto(s)
Alginatos , Movimiento Celular , Proliferación Celular , Fibroblastos , Factor A de Crecimiento Endotelial Vascular , Cicatrización de Heridas , Fibroblastos/efectos de los fármacos , Cicatrización de Heridas/efectos de los fármacos , Humanos , Alginatos/farmacología , Movimiento Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Factor A de Crecimiento Endotelial Vascular/metabolismo , Colágeno/metabolismo , Vendajes , Factor de Crecimiento Transformador beta/metabolismo , Carboximetilcelulosa de Sodio , Células Cultivadas , Células Asesinas Naturales/efectos de los fármacos , Resinas Acrílicas , Ácidos Hexurónicos , Ácido Glucurónico , PielRESUMEN
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.
Asunto(s)
Contractura , Cicatrización de Heridas , Humanos , Adulto , Resultado del Tratamiento , Piel , Trasplante de Piel/métodosRESUMEN
Local conditions can lead to a failure of traditional skin grafts. We propose here our technique about the realization of autologous skin graft using it buried chipped grafts, for wounds in failure of treatments or at risk of failure. The protocol includes cutting the skin graft within little squared pieces of a few millimeters of length, that are then buried directly deep into the wound. We can then obtain little islands of epidermisation on the random places of the wound that will heal by confluence of those epidermal islands.
Asunto(s)
Quemaduras , Trasplante de Piel , Humanos , Trasplante de Piel/métodos , Quemaduras/cirugía , Piel , Cicatrización de HeridasRESUMEN
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.
RESUMEN
We checked the files of 30 inpatients with diabetes and deep burns to the lower limbs. We looked for a diabetes-related neuropathy (60% had one), the context of the accident, the topography of burns, any delays before the first and possible subsequent surgeries, the length of stay, and return to walking, if achieved. Burns mostly involved distal parts of the lower limbs, were thermal in 90% with an intentional action in 43%, and frequently occurred in a bathing room (48%) during a footbath (54%). Mean time to the first surgery was day 3,35 and, when needed, the second one was performed 6,54 days later. Mean LOS was 14,6 days, eleven patients were walking again by this time. We found a significant (p<0.001) association between the time to the 1st surgery and time elapsed between the burn and hospitalization. The existence of a diabetes-related neuropathy is a risk factor of lower limb burns, provided it suppresses the alarm of pain. Early surgery seems to reduce the LOS.
RESUMEN
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.
RESUMEN
INTRODUCTION: All plastic surgeons are frequently faced with patients with Body Dysmorphic Disorder (BDD). However, no screening test exists in French to help the plastic surgeons to diagnose this disease. The Body Dysmorphic Disorder Questionnaire (BDDQ) is the Gold Standard to easily detect BDD in consultation with any non-psychiatric physician. The aim of this study was to translate and validate the BDDQ into French to help plastic surgeons to detect BDD before the surgery. This way, plastic surgeons will be able to provide an optimal medical care and to reduce the risk of psychiatric collapse. METHODS: We asked Katherine Philipps for her approval to use her BDDQ for our study, and thereafter we translated it respecting the criteria of the World Health Organization. We first evaluated the psychometric qualities of the BDDQ in French and then its reproducibility and its sensitivity to change. RESULTS: A French version of the BDDQ appeared to be reliable and comprehensible. The questionnaire has been tested on a sample of patients in plastic surgery consultation, at a T moment and a T plus one month to certify its reproducibility and its sensitivity to change. CONCLUSION: These results permit to claim that the French version of the BDDQ is now validated to detect patients with a BDD in a plastic surgery consultation.
Asunto(s)
Trastorno Dismórfico Corporal/diagnóstico , Tamizaje Masivo/métodos , Psicometría/métodos , Cirugía Plástica/métodos , Encuestas y Cuestionarios , Adulto , Anciano , Comparación Transcultural , Femenino , Francia , Humanos , Tamizaje Masivo/normas , Persona de Mediana Edad , Psicometría/normas , Procedimientos de Cirugía Plástica/psicología , Derivación y Consulta , Reproducibilidad de los Resultados , Encuestas y Cuestionarios/normas , Factores de Tiempo , Traducción , Adulto JovenAsunto(s)
Procedimientos de Cirugía Plástica , Cirugía Plástica , Profilaxis Antibiótica , Humanos , PlásticosRESUMEN
BACKGROUND: Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS: We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS: A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS: Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.
Asunto(s)
Bacteriemia/microbiología , Bacterias Aerobias/aislamiento & purificación , Bacterias Anaerobias/aislamiento & purificación , Cultivo de Sangre/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/etiología , Bacterias Aerobias/patogenicidad , Bacterias Anaerobias/patogenicidad , Cultivo de Sangre/métodos , Quemaduras/complicaciones , Quemaduras/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neutropenia/microbiología , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
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.
RESUMEN
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.
Asunto(s)
Traumatismos del Brazo/cirugía , Arterias/lesiones , Quemaduras por Electricidad/complicaciones , Quemaduras por Electricidad/cirugía , Traumatismos de la Pierna/cirugía , Arteria Radial/lesiones , Adulto , Amputación Quirúrgica , Arterias/cirugía , Fasciotomía , Hemostasis Quirúrgica , Humanos , Masculino , Persona de Mediana Edad , Arteria Radial/cirugía , Rotura Espontánea , Tibia/irrigación sanguíneaRESUMEN
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.
Asunto(s)
Servicios Médicos de Urgencia/ética , Servicios Médicos de Urgencia/legislación & jurisprudencia , Accidentes de Trabajo , Adulto , Quemaduras/terapia , Humanos , Masculino , Trasplante de Piel/ética , Trasplante de Piel/legislación & jurisprudencia , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/legislación & jurisprudenciaRESUMEN
INTRODUCTION: Basal cell carcinoma (BCC) is a pathology that evolves locally and it is common in elderly subjects whose frailty could restrict the indications for the reference treatment, which is based on surgery. The aim of this study was to investigate the morbidity and the mortality associated with surgical treatment of BCC in patients over 75 years of age, so as to identify possible prognostic factors for postoperative complications. MATERIALS AND METHODS: This was a retrospective study carried out with patients over 75 years of age who were treated surgically for one or several BCC between 2010 and 2015 in the reconstructive and cosmetic plastic surgery unit of the Saint-Louis Hospital in Paris (France). We collated the demographic characteristics, the characteristics of the treatment, as well as the rate of major postoperative complications. We performed a univariate and then a multivariate analysis of the various risk factors that were identified. RESULTS: A total of 158 patients were analyzed and they exhibited a rate of major complications of 12%. The statistical analysis identified five significant risk factors: being over 85 years of age (P=0.006), long-term use of anticoagulant treatment (P=0.02), the presence of at least one comorbidity (P=0.018), a conventional hospitalization (P=0.002), and the use of general anesthesia (P=1.2e-10). CONCLUSION: Five risk factors for major postoperative complications with the surgical treatment of BCC in patients over 75 years of age were identified. These factors may provide direction to medico-surgical teams in regard to the optimal treatment of BCC in elderly patients.
Asunto(s)
Carcinoma Basocelular/cirugía , Complicaciones Posoperatorias/etiología , Neoplasias Cutáneas/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Anestesia General/efectos adversos , Anticoagulantes/efectos adversos , Comorbilidad , Femenino , Francia , Hospitalización , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Cross-talk between skin keratinocytes (KCs) and Langerhans cells (LCs) plays a fundamental role in the body's first line of immunological defences. However, the mechanism behind the interaction between these two major epidermal cells is unknown. Interleukin (IL)-32 is produced in inflammatory skin disorders. We questioned the role of IL-32 in the epidermis. OBJECTIVES: We aimed to determine the role of IL-32 produced by KCs on surrounding LCs. METHODS: We used an ex vivo human explant model from healthy donors and investigated the role of IL-32 on LC activation using imaging, flow cytometry, reverse transcriptase quantitative polymerase chain reaction and small interfering (si)RNA treatment. RESULTS: Modified vaccinia virus ankara (MVA) infection induced KC death alongside the early production of the proinflammatory cytokine IL-32. We demonstrated that IL-32 produced by MVA-infected KCs induced modest but significant morphological changes in LCs and downregulation of adhesion molecules, such as epithelial cell adhesion molecule and very late antigen-4, and CXCL10 production. The treatment of KCs with IL-32-specific siRNA, and anti-IL-32 blocking antibody significantly inhibited LC activation, demonstrating the role of IL-32 in LC activation. We also found that some Toll-like receptor ligands induced a very high level of IL-32 production by KCs, which initiated LC activation. CONCLUSIONS: We propose, for the first time, that IL-32 is a molecular link between KCs and LCs in healthy skin, provoking LC migration from the epidermis to the dermis prior to their migration to the draining lymph nodes.