Histoire Du Traitement Des Brûlures En France. La Place De L'Hôpital Léon Bérard (Hyères) : Rééducation, Société Savante, Association De Patients.

In the 50s and 60s, before burn centres appeared, burn patients were primarily treated in surgical departments. They were then referred to sanatorium-type institutions, moving towards functional rehabilitation but without a really structured service. In the early 70s, Jean-Pierre Jouglard, Marseille Surgeon, Head of the Burn Treatment Center of the University Hospital of Marseille, collaborated with Dr. Madeleine Malavaud, in an RRF establishment, the Léon Bérard Hospital in Hyères (Var), to create, in 1974, the first French service dedicated to the rehabilitation of burn patients. The Léon Bérard hospital's burn rehabilitation service, which is still active today, helped spread new techniques from the United States of America to France in the 80s, by training young doctors to become rehabilitators. In 1979, it contributed to the creation of the French Society for the Study and Treatment of Burns, enabling patients to compare their experience by promoting the creation of the Association des Brûlés de France in 1983. The Léon Bérard hospital's burn rehabilitation service therefore occupies a prominent place in the history of burn rehabilitation in France.

Dermal regeneration template for deep hand burns: clinical utility for both early grafting and reconstructive surgery.

Adequate acute treatment of the deeply burned hand and any subsequent reconstructive procedures may be hampered by the lack of sufficient suitable graft material and the risks of donor site morbidity and scarring. This investigation was designed to determine the feasibility of treating deep hand burns using a dermal regeneration template. Patients with deep hand burns underwent either acute treatment or reconstructive procedures with Integra dermal regeneration template. Wound sites were first grafted with the dermal regeneration template, and then 2-3 weeks later after neodermis formation the silicone layer of the Integra was removed and a very thin split-thickness epidermal autograft placed. Acute grafting was performed on 15 hands in 11 patients and reconstructive surgery on 14 hands in 11 patients. Median follow-up was 12 months. Integra take was 100% on all treated hands. After acute grafting the wound site skin was flexible and supple and did not adhere to the deeper layers, thus permitting free articular and functional movement. Cosmetic results of acute surgery were judged satisfactory by both patients and surgeons. After reconstructive procedures, significant improvements were achieved in cosmetic status, based on Vancouver Scar Scale (p=0.0002), and in three measures of function, namely, thumb opposition score (p=0.0005), fingertip-to-palm distance (p=0.0039) and prehensile score (p=0.0039). Favourable cosmetic and functional outcomes were consistently attained using a synthetic dermal regeneration template for treatment of deep hand burns either by acute grafting or reconstructive surgery.

[Integra, a new surgical alternative for the treatment of massive burns. Clinical evaluation of acute and reconstructive surgery: 39 cases]. / Intégra, une nouvelle alternative chirurgicale pour le traitement des grands brûlés. Evaluation clinique en chirurgie aiguë et réparatrice: à propos de 39 cas.

Early excision and prompt coverage in severely burned patients are the best way to lessen morbidity and improve survival. Repair of full-thickness burns requires replacement of both dermal and epidermal components of skin and treatment with split thickness autografts replaces both of them. But healthy skin is not sufficient in extensive burns. Alternative to split thickness skin grafts have been studied by several groups including epidermis, dermis or a complete replacement comprising epidermis and dermis. Because of the difficulties in homografts supplying, a new way was use to replace the dermis. In 1981, Yannas and Burke were the first to develop such a matrix. Intégra is available in France since 1997 and was used in our service for the treatment of both acute and reconstructive surgery for burned patients. Twenty patients were treated for acute surgery. Nineteen patients were treated for reconstructive surgery of burn scar contractures. Fifty-one grafts of Intégra were performed. Long-term final results seem to show that Intégra improve cosmetical and functional results and is a new surgical alternative for the treatment of burns in the acute phase as well as in late surgery of deformities.

[Device of the burnt face. Role of compression and splints]. / L'appareillage de la face brûlée. La place des compressions et des conformateurs.

The face is one of the areas of the body most frequently affected by burns. Pressure therapy maintains facial scars until maturation is achieved to present hypertrophic scars or contractures. Elastic pressure garments are usually used, but they do not provide adequate pressure on areas such as naso-labial folds or labio-chin folds. Silicone splints are therefore added under this elastic face mask. A rigid transparent face mask or silicone face mask allows better management of facial scars. A positive plastic mold is obtained from a negative alginate mold of the patient's face. A high temperature plastic is heated and stretched on to the positive mold. The mask is worn continuously excepted when bathing eating and rehabilitation. Follow up is necessary to prevent complications and to revise the mask as the scars change. Nostril and oral commissures are treated with inserts which maintain adequate size or corrected contractures. Satisfactory results can be obtained with cooperative patients.

[Recovery after anesthesia with propofol in otorhinolaryngologic surgery of brief duration]. / Le réveil après anesthésie au propofol pour chirurgie ORL de courte durée.

This study was designed to assess recovery from total intravenous anaesthesia with propofol for short ENT procedures. Twenty-six patients (ASA I and II) were assigned to two groups of thirteen: one breathed air (Laser laryngeal microsurgery), the second N2O-O2 (FIO2 : 0.5) (various ENT procedures). The induction sequence was exactly the same for both groups: oral premedication with 10 mg diazepam one hour before surgery, I mg pancuronium bromide, 2 micrograms X kg-1 fentanyl, denitrogenation within 3 min, after which propofol was delivered (2.5 mg X kg-1). When the eye-lash reflex had disappeared (time recorded), 1.5 mg X kg-1 suxamethonium was given and laryngotracheal intubation carried out. A continuous infusion of propofol (9 mg X kg-1 X h-1) was started. Surgery began 5 +/- 2 min after the start of propofol infusion. The durations of anaesthesia, surgery and propofol infusion were similar in both groups. To have good surgical conditions, it was necessary to give repeated doses of propofol for 15 patients. Thus, the total dose of propofol was significatively different between the two groups: 24.5 +/- 6.7 mg X kg-1 X h-1 in group "air" versus 16 +/- 3.6 mg X kg-1 X h-1 in group "N2O-O2" (p less than 0.001). Extubation occurred within 16 +/- 8 min in group "air", being more rapid in group "N2O-O2" (11 +/- 9 min; no significant difference). Recovery was assessed with two psychomotor tests: choice reaction time (CRT) and tracing test (TT).(ABSTRACT TRUNCATED AT 250 WORDS)