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Background Centre hospitalier de l’Université de Montréal in Canada introduced accompanying patients (APs) into the breast cancer care trajectory. APs are patients who have been treated for breast cancer and have been integrated into the clinical team to expand the services offered to people affected by cancer. This study describes the profiles of the people who received the support and explores whether one-offs vs ongoing encounters with APs influence their experience of care, on self-efficacy in coping with cancer, and on their level of psychological distress. Methods An exploratory cross-sectional study was carried out among patients to compare patients who had one encounter with an AP (G1) with those who had had several encounters (G2). Five questionnaires were administered on socio-demographic characteristics, care pathway, evaluation of the support experience, self-efficacy in coping with cancer, and level of psychological distress. Logbooks, completed by the APs, determined the number of encounters. Linear regression models were used to evaluate the associations between the number of encounters, patient characteristics, care pathway, number of topics discussed, self-efficacy measures in coping with cancer, and level of psychological distress. Results Between April 2020 and December 2021, 60% of 535 patients who were offered support from an AP accepted. Of these, one hundred and twenty-four patients participated in the study. The study aimed to recruit a minimum of 70 patients with the expectation of obtaining at least 50 participants, assuming a response rate of 70%. There were no differences between G1 and G2 in terms of sociodemographic data and care pathways. Statistical differences were found between G1 and G2 for impacts on and the return to daily life (p = 0.000), the return to the work and impacts on professional life (p = 0.044), announcement of a diagnosis to family and friends (p = 0.033), and strategies for living with treatment under the best conditions (p = 0.000). Significant differences were found on the topics of cancer (p = 0.000), genetic testing (p = 0.023), therapeutic options (p = 0.000), fatigue following treatment (p = 0.005), pain and discomfort after treatment or surgery (p = 0.000), potential emotions and their management (p = 0.000) and the decision-making processes (p = 0.011). A significant relationship was found between the two groups for patients’ ability to cope with cancer (p = 0.038), and their level of psychological distress at different stages of the care pathway (p = 0.024). Conclusions This study shows differences between one-time and ongoing support for cancer patients. It highlights the potential for APs to help patients develop self-efficacy and cope with the challenges of cancer treatment.

BACKGROUND Management of severe symptomatic immune-related adverse events (IrAEs) related to immune-checkpoint inhibitors (ICI) can be facilitated by timely detection of these complications. As patients face a heterogeneous set of symptoms outside the clinical setting, remotely monitoring and assessing symptoms using patient-reported outcomes (PRO) may result in shorter delays between symptom onset and clinician detection. OBJECTIVE This study is designed to assess the effect of a model of care based on PRO data on the time to detection of symptomatic IrAEs from symptom onset. METHODS 198 patients with cancer receiving systemic treatment comprised exclusively of ICI will be recruited from two Swiss university hospitals. Patients are randomized (1:1) to a digital model of care (intervention) or usual care (control group). Patients are enrolled for six months and use an electronic application to complete questionnaires. Patients in the intervention group complete a weekly PRO-CTCAE™ questionnaire and reassess active symptoms daily for the first three months. Nurses call patients in the event of new or worsening symptoms and manage them, using a standardized triage algorithm. Outcomes of interest include time to IrAE detection (primary outcome), time to IrAE intervention, IrAE grade (severity), health-related quality of life, self-efficacy and overall survival. RESULTS This study has received funding from the ISREC foundation and Kaiku Health Ltd. It is in active recruitment since November 2021 and is projected to conclude in November 2023. Trial results will be disseminated through publications in scientific journals, abstracts and presentations submitted at international scientific conferences. CONCLUSIONS This trial is among the first trials to use PRO data to directly influence routine care of patient treated with ICI. It aims to demonstrate the challenges of diagnosing and managing symptoms associated with treatment remotely, providing further insight into the burden they represent to patients on a daily basis. CLINICALTRIAL ClinicalTrials.gov Identifier : NCT05530187

Goals/Purpose The ligamentous system supporting the penis is widely called « penile suspensory ligament ». It supports and attaches the penis to the abdominal wall and the pubic bone. However, the complexity of the anatomy of the penile suspensory system was underestimated. The aim of this anatomical study was to describe the different ligamentous (features, insertion sites, path) and their functions. Methods/Technique The first step consisted in a description of the different components of the penile suspensory apparatus on two cadavers embalmed by the Thiel method. The second part was an evaluation of the function of each ligament on freshly dead cadavers. In the third stage, we applied those findings to an exploratory cohort of patients undergoing a penile lengthening surgery for buried penis. Results/Complications The penile suspensory apparatus consisted in four ligaments from anterior to posterior : the fundiform ligament, the suspensory ligament, dense vertical ligament and the arcuate ligament. The first two were loose, non-stabilizing and the two posterior ones were dense and stabilizing. In our cohort, 12 patients were included. The mean BMI was 38. The mean pre-operative flaccid length was 4.1 cm [2.2 cm – 7 cm] and at 6 months 8.2 cm [5.2 cm - 11.5 cm] which represents a mean augmentation of 100%. The mean pre-operative circumference at a flaccid state was 8.2 cm [2 cm – 11.5 cm] and at 6 months post-operative was 12.6 cm [8.3 cm - 16 cm] which represents a mean augmentation of 85.7%. The most common complication was a phimosis. Conclusion We have described the detailed anatomy of the penile suspensory apparatus. It is the first time that the dense vertical ligament was brought to light. To avoid instability in penile lengthening, the posterior part of the dense vertical ligament and the arcuate ligament must be spared.

Resume Introduction L’utilisation des medias sociaux a ete un bouleversement majeur de nos modes de vie dans la derniere decennie, A l’avant-garde dans la crise du lymphome anaplasique a grandes cellules lie aux implants mammaires -LAGC–AIM-, des fevrier 2019, notre centre universitaire a pris des mesures pour identifier et contacter toutes les patientes porteuses d’implants macro-textures. L’objectif de ce rappel etait d’informer les patientes sur les signes d’alerte et d’etablir une modalite de surveillance. Le but de ce travail est d’analyser les decisions des patientes suite a ce processus et de voir si la participation a un des groupes Facebook influencait cette prise de decision. Methodes Une etude retrospective de la cohorte de patientes, ayant demande et assiste a des rendez-vous avec un chirurgien, a ete faite. Le nombre de patientes presentant des signes cliniques d’alertes de LAGC–AIM, le nombre de patientes qui ont demande une intervention chirurgicale d’explantation de l’implant, les diagnostics histologiques retrouves apres la chirurgie ont ete colliges. Nous avons ensuite calcule la proportion de membres du groupe Facebook chez les patientes ayant exige une ablation d’implant en l’absence de diagnostic ou meme de signes d’alerte. Resultats Sept cent soixante-dix femmes ont demande un rendez-vous avec l’un des chirurgiens de notre service. De toutes les femmes qui ont demande une consultation, 497 (64,55 %) ont presente des symptomes. Seules 25 % des patientes, ayant consulte, avaient frequente un des groupes de patientes sur le reseau Facebook. Au terme de la consultation avec leur chirurgien, pres d’un quart des patientes ont un pris une decision d’ablation de l’implant contre l’avis medical. Parmi ces patientes, 67 % faisaient partie d’un groupe de patientes sur le reseau Facebook. A ce jour, aucun patient n’a recu de diagnostic de LAGC–AIM. Conclusions Ces resultats viennent supporter l’hypothese que l’appartenance a des groupes de patientes sur Facebook devient pour certaines un element cle du processus de decision.

Study Design Pilot randomized controlled trial with parallel groups. Introduction Engaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. Purpose of the Study To assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). Methods Thirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. Results Thirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. Discussion Engaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program’s content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. Conclusion A preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials.

Implant malposition remains one of the main complications of aesthetic breast augmentation and alloplastic breast reconstruction with expanders and implants. Many capsulorrhaphy techniques have been described to adjust the breast pocket and correct the malposition. In this study, we tested the efficacy of the argon beam coagulator (ABC) for lateral capsulorrhaphy on breast reconstruction patients at the time of expander replacement with a permanent implant. We also experimentally compared the effects of the ABC and the standard electrocautery on fragments of healthy breast capsule. We noted a 69.5% capsule shrinkage with the ABC versus 46.8% with the standard electrocautery. We concluded that breast capsulorrhaphy using the ABC is a safe and efficient technique for the correction of breast implant malposition in both reconstructive and aesthetic breast surgery.

With surgical education moving from a time-based to a competency-based model, developing high-fidelity simulation models has become a priority. The Thiel cadaveric model has previously been used for a number of medical and surgical simulations, including microvascular simulation. We aim to investigate the use of the Thiel model in peripheral nerve simulation and validate a novel evaluation instrument. Sixteen residents ranging from postgraduate years 1 to 6 participated in the study. Their nerve coaptations using Thiel cadaveric nerves were video recorded and evaluated by 5 fellowship-trained microsurgeons using the Micro-Neurorrhaphy Evaluation Scale (MNES). The intraclass correlation among the 5 evaluators was 0.75, revealing excellent interrater reliability. The Cronbach α was .77, underlining the internal consistency of the test items. Bivariate analysis revealed a significant association between the MNES scores and the participants' self-declared level of experience. This correlation was confirmed by mixed modeling. Our results validate the MNES and underscore the utility of the Thiel nerve tissue for peripheral nerve surgical simulation.Puisque l’enseignement de la chirurgie passe d’un modèle axé sur le temps à un modèle axé sur les compétences, il est devenu prioritaire de créer des modèles de simulation haute fidélité. La méthode cadavérique de Thiel a déjà été utilisée pour plusieurs simulateurs médicaux et chirurgicaux, y compris la simulation microvasculaire. Les chercheurs ont l’intention de l’explorer pour la simulation des nerfs périphériques et de valider un nouvel instrument d’évaluation. Seize résidents de première à sixième année ont participé à l’étude. Leur coaptation nerveuse à l’aide des nerfs cadavériques de Thiel a été enregistrée sur vidéo et évaluée par cinq microchirurgiens possédant un postdoctorat à l’aide de l’échelle d’évaluation de la microneurorraphie (ÉÉMN). La corrélation intraclasse entre les cinq évaluateurs était de 0,75, révélant une excellente fiabilité interévaluateur. Le coefficient alpha de Cronbach était de 0,77, soulignant la cohérence interne des éléments à l’essai. L’analyse bivariée a révélé une association significative entre les scores d’ÉÉMN et le taux d’expérience déclaré par les participants. Cette corrélation a été confirmée par modélisation mixte. Les résultats des chercheurs valident l’ÉÉMN et soulignent l’utilité des tissus nerveux de Thiel pour la simulation chirurgicale des nerfs périphériques.

Biofilm forms when bacteria surrounded by an extracellular matrix aggregate on a surface. It can develop on many surfaces, including wound dressings; this can be particularly nefarious for burn patients undergoing skin grafting (autograft) for burn wound coverage as they often suffer from compromised immune system function. Autograft donor sites are particularly vulnerable to biofilm formation; as such, timely healing of these sites is essential. Our aim was to apply scanning electron microscopy to compare the efficacy of two types of wound dressings in preventing the formation of bacterial biofilm on burn patient skin graft donor sites. One dressing contained bismuth tribromophenate at a concentration of 3% which confers it bacteriostatic properties (Xeroform™). The other was an absorptive alginate calcium sodium dressing (Kaltostat™). Samples of each wound dressing, which were in contact with the skin graft donor site, were prepared for analysis under the scanning electron microscope (SEM) using an original method developed by our research group that aims to maintain the integrity of the biofilm microstructure. Samples prepared by this method were then analyzed using SEM, which allowed the characterization of biofilm and the evaluation of bacterial density on the studied dressing samples. To this day, this imaging technique has been rarely employed for dressing analysis and this is the first time that it is employed for in situ biofilm visualization for this particular application.

Frostbite causes tissue damage through five major mechanisms, out of which two are amenable to treatment. The first-line treatment is rapid rewarming therapy using water at 40°C to 42°C, which addresses the formation of ice crystals in the intra and extra cellular compartments. The second mechanism is progressive tissue ischemia after rewarming and is only accessible to a second-line therapy represented by thrombolysis. This study aimed to determine the efficacy of thrombolysis. This is a single-center retrospective cohort study, where it was aimed to evaluate two groups of patients. A total of 18 patients were included in this study. Mean times between injury to thrombolytic therapy and admission to thrombolytic therapy was 26.04 hours (SD 13.6) and 9.65 hours (SD 9.89), respectively. All patients suffered injuries ranging from second-degree deep to third degree. The rate of patients having complete, partial, and no angiographic responses were 55.6%, 11.1%, and 33.3%, respectively. The main outcome of interest showed that 11 (61.1%) patients in total had amputations at different levels. Results showed that in the intervention group, five (55.6%) of the patients had amputations compared with six (66.7%) from the control group (P = .6) at comparable levels of amputation. The literature supports that the use of intra-arterial tissue plasminogen activator might be beneficial for severe cases of frostbites; however, it lacks of studies of major significance and results are often controversial. Our study has not shown statistically significant results on amputation levels and cannot support the hypothesis of efficacy of thrombolytic therapy.

Background Although increasingly reported in the literature, most plastic surgeons cannot define the etiology of double capsules. Often an incidental finding at implant exchange, double capsules are frequently associated with macrotextured devices. Several mechanisms have been proposed, including at the forefront that shearing causes a delamination of the periprosthetic capsule into a double capsule. Objectives This study was designed to confirm the hypothesis that mechanical forces are involved in formation of double capsules by histological analysis. Methods A prospective analysis of consecutive implants with double capsules removed over 2 years was performed. Data collected at the time of surgery included Baker classification, reason for explant, implant manufacturer and style, and any presence of a seroma associated with the capsule. Specimens were sent for analysis by histology utilizing hematoxylin and eosin and alpha-smooth muscle actin staining techniques. Results Eight double capsules were collected for specimen analysis. All capsules demonstrated evidence of granulation tissue, alpha-smooth muscle actin positive myofibroblasts, and folds with embedded texture. Fibrosis surrounded weak areas with presence of layering and splitting, creating a potential space that is prone to separation. Tears and folds from granulomatous reaction are also present within the outer layer of the double capsule, which can only be explained by a mechanical shearing force as a pathogenic mechanism. Conclusions Understanding the pathogenesis of double capsules may allow plastic surgeons to refine their indications for macrotextured implants while providing guidance to patients on avoidance of activities that produce shear-forces. The findings support the hypothesis that shearing forces delaminate the capsule into 2 separate distinct capsules. Level of Evidence: 5

The Thiel embalmment method has recently been used in a number of medical simulation fields. The authors investigate the use of Thiel vessels as a high fidelity model for microvascular simulation and propose a new checklist-based evaluation instrument for microsurgical training.Thirteen residents and 2 attending microsurgeons performed video recorded microvascular anastomoses on Thiel embalmed arteries that were evaluated using a new evaluation instrument (Microvascular Evaluation Scale) by 4 fellowship trained microsurgeons. The internal validity was assessed using the Cronbach coefficient. The external validity was verified using regression models.The reliability assessment revealed an excellent intra-class correlation of 0.89. When comparing scores obtained by participants from different levels of training, attending surgeons and senior residents (Post Graduate Year [PGY] 4-5) scored significantly better than junior residents (PGY 1-3). The difference between senior residents and attending surgeons was not significant. When considering microsurgical experience, the differences were significant between the advanced group and the minimal and moderate experience groups. The differences between minimal and moderate experience groups were not significant. Based on the data obtained, a score of 8 would translate into a level of microsurgical competence appropriate for clinical microsurgery.Thiel cadaveric vessels are a high fidelity model for microsurgical simulation. Excellent internal and external validity measures were obtained using the Microvascular Evaluation Scale (MVES).La méthode d’embaumement Thiel a récemment été utilisée dans divers domaines de simulation médicale. Les auteurs explorent l’utilisation des vaisseaux Thiel comme modèle haute-fidélité pour la simulation microvasculaire et proposent un nouvel instrument d’évaluation de formation à la microchirurgie reposant sur une liste de vérification.Treize résidents et deux microchirurgiens traitants ont effectué des anastomoses microvasculaires sur des artères embaumées Thiel. Quatre microchirurgiens surspécialisés en ont évalué l’enregistrement à l’aide d’un nouvel instrument (échelle de simulation microchirurgicale en dix étapes). Ils ont évalué la validité interne au moyen du coefficient de Cronbach et vérifié la validité externe à l’aide de modèles de régression.L’évaluation de fiabilité a révélé une excellente corrélation intraclasse de 0,89. Lorsqu’on compare les scores obtenus par des participants de divers niveaux de formation, les chirurgiens et les résidents seniors (de quatrième ou cinquième année) ont obtenu des résultats significativement supérieurs à ceux des résidents juniors (de première à troisième année). La différence entre les résidents seniors et les chirurgiens traitants n’était pas significative. Les différences d’expérience microchirurgicale étaient significatives entre le groupe avancé et les groupes ayant une expérience minime ou modérée. D’après les données obtenues, un score de 8 désignerait un niveau de compétence microchirurgicale acceptable pour la microchirurgie clinique.Les vaisseaux cadavériques Thiel sont un modèle haute-fidélité de simulation microchirurgicale. D’excellentes mesures de validité interne et externe ont été obtenues au moyen de l’échelle de simulation microchirurgicale en dix étapes.

Summary Purpose Our aim is to do a comparative qualitative analysis of patents and “User Manuals” of the Biocell textured implants in order to determine if red flags were omitted when marketing and using Biocell textured implants. Materials and methods We performed a systematic qualitative analysis using the NVivo software version 11 of the patents describing the Biocell textured implants prior to their approval by the FDA and of user guides published by the 3 companies owning the patents (McGhan, Inamed, Allergan). To guide our thematic analysis, we used a form of systems theory known as the complexity theory. Results Four patents related to Biocell and 2 user manuals (McGhan- Inamed and Allergan) were analyzed. Four themes emerged from the patents: invention description, mechanism of action (Tissue ingrowth), the timing of the mechanism of action and hypothetical actions on capsular contractures prevention. Of all patent's content, 34% described the invention, 29% the mechanism of action (tissue ingrowth), 1% the timing of this mechanism of action and 34% a hypothetical action against capsular contracture. Solid evidence was found on the concept of anchoring and very little on capsular contracture. On the user guide side, the main themes were indications and contraindications, surgical techniques and long-term effects. The “directed” content analysis approach of the user guides regarding the patent's themes reflected that 94% of the user guides content related to the patent thematics was about the hypothetical role on capsular contracture while only 4% was about invention description and 1.5% about tissue ingrowth. Conclusions This analysis highlights the discrepancies between patents of Biocell textured implants and user guides for these implants. The indications of use of a treatment or device can evolve quicker than the study of its potential complications and side effects. The BIA-ALCL crisis should serve as a cautionary tale to the plastic surgery community which embraces new technologies eagerly, and sometimes precariously, in a mission to advance patient care.

Summary Background Simulation models are increasingly important for skill acquisition during microsurgery training. Prosthetics, living and non-living biological models have been proposed in the literature in the optics of recreating real-life scenarios in a controlled environment. This study aims to validate and prove the reusability of a novel non-living biological model: the porcine placenta. Methods A prospective comparative study was carried out to assess face and content validities of the proposed model, as well as the reusability and quality of the Thiel-embalming method. Participants were asked answer a questionnaire for each anastomosis they performed on porcine placental vessels of ≤ 2 mm (small) and 2–4 mm (large). Scores were classified according to different subgroups, either small or large vessels and first or second sessions. Reliability analysis of the questionnaire was carried out using Cronbach's α, to ensure an α > 0.7. Median scores for each question were analyzed using boxplots and compared amongst each subgroup using a non-parametric independent Mann-Whitney U test. Results With nine participants, the Cronbach's α for each category of question was 0.867, 0.778, 0.720 and 0.593. Statistical differences were found between responses of small and large vessels on 5/10 questions, where large vessels reported higher validity. No statistical differences were found between scores of the first and second sessions. Conclusion By evaluating face and content validity, the Thiel-embalmed porcine placenta has proven its suitability as a microsurgery model, especially for vessels of larger caliber. Qualities that distinguish this model is its reliable reusability, its low cost-effectiveness, and its ethical acceptability.

Summary Classically, history of prior abdominal liposuction has been considered a relative contraindication for breast reconstruction using deep inferior epigastric perforator (DIEP) flap. The rationale for this is based on the fact that liposuction can possibly damage perforating vessels, which could compromise flap survival. However, multiple recently published reports have shown that imaging using CT angiography or colour Duplex ultrasonography could be used to accurately assess the adequacy of the perforating vessels before DIEP flap harvest. This contraindication is currently being reconsidered in the scientific literature. We present a case of partial DIEP flap loss in a patient with history of abdominal liposuction that happened despite preoperative identification of adequate perforators using CT angiography and intraoperative clear evidence of patent anastomoses. This occurrence reopens in our view the question of whether DIEP flaps can be safely performed on patients with a history of abdominal liposuction, even in the presence of adequate perforators on regular CT angiography or Doppler ultrasonography. While abdominal liposuction may not injure perforating vessels, its detrimental effect on linking micro-vessels within the flap cannot be fully evaluated using CT Angiography. Therefore, the use of another imaging modality, such as the indocyanine green laser angiography, to assess perfusion before DIEP flap harvesting is performed and could be considered in patients with history of abdominal liposuction.

Summary Background The use of hormone therapy (tamoxifen and aromatase inhibitors) has been shown to increase venous thromboembolism. However, while estrogens play a crucial role in wound healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative breast reconstruction complications, including infections, necrosis, capsular contracture and seroma. As breast cancer patients undergoing Implants-ADMs breast reconstruction are often receiving hormone therapy, it is unclear whether this increased infection risk is associated with increased infections cases. Methods A prospective study was performed on patients undergoing breast reconstruction at an academic institution from 2013 to 2016. Patients were divided by use of hormone therapy at the time of surgery. Complication rates, including infections, necrosis, seroma and hematomas, were compared and analyzed using univariate and logistic regression models. Results Among a total of 112 patients (183breasts), 58 patients (91 breasts) were receiving hormone therapy and 54 patients (92 breasts) were not. The hormone therapy group had a higher incidence of postoperative mastectomy skin infection (20.7% versus 7.4%; P = 0.0447), we didn’t find any significant differences in necrosis. Conclusions Hormone therapy was associated with a higher incidence of Infections after breast reconstruction with ADMs and implants. The authors propose an individualized approach to the preoperative cessation of tamoxifen or aromatase inhibitors. Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: does hormone therapy increases the risk of infection?

Background Skin coverage remains a significant hurdle in large-sized burns. Recent advances have allowed to grow Bilaminar Cultured Skin Autografts (BCSGs) from patients’ own donor sites. The aim of this study was to report long-term outcomes in patients with large-sized burns having received BCSGs. Methods Nine patients received BCSGs from January 2010 to May 2015. Except one patient who died during hospitalization, all patients were contacted. Four agreed to partake in the study. Patients were tested with the Vancouver Scar Scale (VSS), QuickDASH questionnaire and Burn Specific Health Scale (BSHS). Incisional biopsies of BCSGs were compared with patients’ autografts. Results From nine patients, mean age was 40 years and mean TBSA was 70.3%. For the four patients included, score averaged was 2.25 on the VSS, 29.5 on QuickDASH, 36/36 for psychosocial items and 63/84 for functional abilities on the BSHS. Compared with autografts, BCSGs demonstrated better pliability VSS and functionality. Biopsies showed no evidence of malignancy or atypical changes, but areas of hyperpigmentation. Conclusion This is the first report investigating the long-term outcome of a newly developed BCSG. BCSGs demonstrated comparable results with patients’ autografts, functional outcomes on self-reported questionnaires and excellent psychological states. Precaution given the extensive unexpected hyperpigmentation must be taken and a randomized controlled study is underway.

Acellular dermal matrices have become a mandatory tool in reconstructive breast surgery. Since their introduction, they have been considered to be nonreactive and nonimmunogenic scaffolds. However, some patients who undergo implant-based breast reconstruction with acellular dermal matrices develop postoperative cutaneous erythema overlying their matrices, a condition commonly referred to as red breast syndrome. The aim of this study was to gain a better understanding of this phenomenon. An analysis was conducted on consecutive patients who underwent acellular dermal matrix- and implant-based breast reconstructions and developed red breast syndrome that was treated surgically between April of 2017 and June of 2018 at the authors' institution. During surgery, 1-cm specimens of acellular dermal matrix were sampled and analyzed by scanning electron microscopy. Observations were charted to score and record the presence and thickness of biofilm, and for identification of bacteria. These measurements were performed using Adobe Photoshop CS6 Extended software. Six postmastectomy breast reconstruction patients were included, all with AlloDerm Ready-to-Use-based reconstructions. All specimens were colonized by various bacteria ranging from Gram-negative bacilli to Gram-positive microorganisms. Biofilm was present in all studied specimens. The cause of skin erythema overlying acellular dermal matrix grafts, and the so-called red breast syndrome, may be related to contamination with various bacteria. Although contamination was omnipresent in analyzed samples, its clinical significance is variable. Even if acellular dermal matrix-based reconstructions are salvaged, this could come at the price of chronic local inflammation.

Background After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of informed consent. Methods A retrospective survey was administered to patients with thumb amputations. Participants were required to complete a questionnaire about patient demographics, the Brief Michigan Hand Questionnaire (bMHQ), the standard gamble/time trade-off questionnaires for utility scores, and a questionnaire investigating potential reasons for electing not to undergo a free toe transfer. Results Thirty patients were enrolled in the study wherein 53% underwent a replantation procedure, 27% a revision amputation, and 20% a delayed reconstruction. Mean normalized score on the bMHQ was recorded as 63.54. Utility questionnaires yielded mean measures of 0.8967 and 0.86 on the standard gamble and time trade-off, respectively. From 14 elements, a majority (87%) stated flap failure as a major source of concern, followed by lack of understanding of risks and benefits (80%) and prolonged hospital stay (53%). Cultural/religious beliefs, aesthetic appearance of the foot, and concerns about footwear were not reported as important reasons in 90, 80, and 79% of patients, respectively. Conclusion A better understanding of patients' attitudes and beliefs with respect to free toe flaps will allow surgeons to better address their concerns during informed consent. This study emphasizes the importance to discuss about failure rates, risks, and benefits of the operation and prolonged hospital stay.

Background Despite benefits in reducing capsular contractures, textured implants have been associated with significant pitfalls, such a propensity for biofilm formation. Few studies have investigated whether the use of acellular dermal matrix on textured implants produces similar findings. This study aims to characterize biofilm formation at the capsular-acellular dermal matrix interface with scanning electron microscopy. Methods The authors performed a prospective observational pilot study in patients undergoing two-stage expander-to-permanent implant exchange. Patients were inflated with Biocell or Siltex expanders, and specimens from the capsular-pectoralis interface and capsular-acellular dermal matrix interface were obtained and examined under scanning electron microscopy for capsular ingrowth and biofilm formation using the Van Herdeen Biofilm Grading System and the Biofilm Thickness Grading Scale. Results Nine patients including 14 breasts (28 capsular samples in total) were examined. Thick biofilm formation was observed in all specimens from the capsular-acellular dermal matrix interface with Biocell and 25 percent of capsule-pectoralis interface, whereas no biofilm formation was found in Siltex implants. For Biocell implants, a significant difference in biofilm coverage between the upper and lower poles was observed using the Van Herdeen Biofilm Grading System (p = 0.0028) and the Biofilm Thickness Grading Scale (p = 0.0161). Conclusions Biocell implants produce a significant rate of biofilm formation over acellular dermal matrix-covered capsules, which is not present in the muscular region or in Siltex implants. Further randomized controlled trials will further elucidate the clinical impact of using acellular dermal matrices with macrotextured implants. Clinical question/level of evidence Therapeutic, IV.

Background To prevent postoperative thrombosis, indications for anticoagulation in finger replantation have been described, but no consensus has yet been found for cessation protocols. The aim of this study is to investigate cessation methods of intravenous anticoagulation after finger replantation. Methods A retrospective review of all patients treated for a finger replantation between December 2014 and July 2016 was performed. Only those who required postoperative treatment with intravenous heparin were extracted. Primary outcome was survival of finger at hospital discharge and data collection focused on postoperative anticoagulation regimens. Results 108 patients with replantation were treated with intravenous heparin and included in the analysis. When anticoagulated, survival rate was 60% (n = 65) at hospital discharge, wherein arterial and venous thrombosis accounted for 60 and 40% respectively. Descriptive analysis failed to demonstrate an increase in failure rates when tested for duration of intravenous heparin, fixed or variable infusion rates of anticoagulation and need for vascular grafts. However, there was a 2.8-fold (P = .009) increase in the survival rate with progressive weaning of anticoagulation rather than abrupt discontinuation. Subgroup analysis demonstrated similar findings when considering arterial thrombosis alone (OR 5.2, P = .012), but did not show any significant difference for venous thrombosis (OR 1.7, P = .344). Conclusions Progressive tapering of intravenous heparin is associated with an increased survival rate after finger replantation, particularly for arterial thrombosis. Further prospective and randomized trials are necessary to elucidate the optimal duration, method of infusion and indications for vascular grafts.

La recherche dans le domaine de la motivation a démontré que la présence de buts personnels est associée au bien-être psychologique (BEP). Un programme de 14 semaines conçu pour aider les participants à réaliser leurs projets a été offert à des personnes âgées (≥ 65 ans) dépressives (BDI-II ≥ 9; M = 22,05) afin d’améliorer leur BEP. Les niveaux de BEP, de dépression et d’anxiété des personnes qui ont participé au programme (n = 24) ont été comparés à ceux d’un groupe contrôle (n = 18). Les analyses ont montré que les participants au programme se sont améliorés significativement sur la plupart des indicateurs de BEP, incluant la dépression, ce qui semble indiquer qu’un programme de gestion des buts pourrait être une manière innovatrice de promouvoir la santé mentale des aînés dépressifs. Toutefois, l’amélioration est observée uniquement pour la sérénité et le sens à la vie dans les analyses comparatives avec le groupe contrôle. Les études ultérieures devraient tenter de développer des programmes de promotion de la santé mentale qui offrent aux individus des moyens d’atteindre un état de fonctionnement optimal., Research on motivation has shown that the presence of personal goals is related to psychological well-being (PWB). A 14-week program designed to help participants realize meaningful personal projects was created to improve the PWB of depressed (BDI-II ≥ 9; M = 22,05) older adults (≥ 65 years). The levels of PWB, depression, and anxiety of the persons who took part in the program (n = 24) were compared to those of a control group (n = 18). Analyses showed that the program participants improved significantly on most indicators of well-being, including depression, indicating that a goal intervention program could be an innovative way to promote the mental health of depressive older adults. However, the improvement was observed only for serenity and meaning in life in the comparative analyses with the control group. Future studies should try to develop mental health promotion program that provide individuals with means to achieve an optimal state of functioning.

Summary Background Macro-texturing of breast implants was developed with the double goal of improving implant stabilization within the breast cavity and decreasing the rate of capsular contractures. However, recent evidence suggests that double capsular formation, a potentially worrisome phenomenon associated with late seromas and biofilms, occurs with preponderance in macro-textured implants. Our objective was to analyze histologically different regions of double capsules to determine if they are more prone to mechanical movements. Methods A prospective analysis including patients undergoing second-stage expander to definitive breast-implant reconstruction post-mastectomy was conducted after intraoperative identification of the double capsule phenomenon. Two samples were collected from each capsules around the implant, located centrally and laterally. The specimens were sent for histological analysis by the institution's pathologist. Results In total, 10 patients were identified intraoperatively with partial double capsule phenomenon. Among samples retrieved from the lateral aspect of the breast implant, all were associated with delamination and fractures in the collagen matrix of the double capsules. This phenomenon was not observed in any sample from the dome of the breast. Conclusions Breast-implant macro-texturing plays an important role on delamination of capsules on lateral portions of the breast, which may have an etiologic role in double capsule formation. Manufacturing implants with macro-texturing on one side and smooth surface on the other could diminish mechanical shear forces responsible for these findings.

Free flap reconstruction in acute burns has high failure rates, relating mainly to a systemic inflammatory state. The “vulnerable phase” can last for 6 weeks after burn and can cause thrombosis of the flap microcirculation with patent arterial and venous anastomoses. Revision surgery alone may be unsuccessful, but thrombolysis can lead to flap salvage. We describe a case of successful flap salvage with thrombolysis after unsuccessful revision surgery by permeable arterial and venous anastomoses in a patient in the acute burn phase suffering from microcirculatory thrombosis. Thrombolysis in these cases has not been described to date, but it could contribute to salvaging flaps by radiological intervention alone. A 23-year-old man was admitted with a 38% TBSA burn, including loss of all eyelid skin. The right eye was reconstructed in a satisfactory manner, but the left eye required urgent corneal coverage on day 32 with a dorsalis pedis fasciocutaneous free flap. The flap was hypo-perfused postoperatively, but anastomoses were found to be permeable on exploration. Angiography performed postoperatively after revision confirmed anastomotic patency, but failed to demonstrate small vessel beds within the flap. Thus, r-tPa was given at the anastomosis site and immediately the flap recovered completely. However, a total of 10 packed red blood cell transfusions were needed over the next 9 days. Thrombolysis in the context of free flap microvascular compromise may improve the overall success rates, especially in acute-phase burn patients where this etiology may be found, due to a vulnerable inflammatory period.

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal joint osteoarthritis may have both postoperative benefits and complications. This study sought to determine the health state utility outcome measures of trapeziectomy with LRTI. Patients who underwent trapeziectomy with LRTI were invited to complete the brief Michigan Hand Questionnaire and utility questionnaires outcomes using a visual analogue scale , time trade-off and standard gamble. Quality-adjusted life years (QALYs) were derived from these utility measures. For this study 32 patients were recruited, with a mean age of 61. Most patients (27/32) perceived the procedure as successful. Utility measures and QALYs serve the purpose of comparing different surgical procedures in terms of their impact on the quality of life of patients as a function of the benefits and complications of each procedure. In this study, the utility of trapeziectomy with LRTI was less than has been described for open palmar fasciectomy but more than for total wrist arthrodesis.Level of evidence: IV

Background Sensory and motor disturbances are characteristic of musculoskeletal injuries and conditions. Rehabilitation interventions aimed at remediating these disturbances are traditionally exclusively targeted to the affected area. However, there is some evidence of bilateral changes in sensory and motor function associated with unilateral injuries and conditions suggesting central changes. Deficits on specific cognitive tasks have also been documented in persons with chronic pain. Purpose The purpose of the present study was to determine if participants with unilateral pain arising from heterogeneous wrist/hand injuries and conditions demonstrate bilateral changes in sensory and motor functions as well as cognitive deficits. Design/methods Sensory (Pressure Pain Thresholds, Two Point Orientation Discrimination), Motor (grip strength and Purdue Pegboard), and Cognitive function (Stroop test and mental rotation task) were measured in 30 participants with wrist/hand pain and 30 healthy control participants in an observational cross-sectional study. Results Participants with unilateral wrist/hand pain demonstrated differences in cognitive function measured with the Stroop test (p = 0.03). They also demonstrated bilateral sensorimotor differences in pressure pain thresholds (p = 0.03), grip strength (p = 0.00) and Purdue pegboard test (p = 0.03) results compared to healthy control participants. Conclusion Cognitive as well as bilateral alterations in sensory and motor function in participants with musculoskeletal injuries and conditions suggest central changes are involved in their pathophysiology. These findings in persons with heterogeneous injuries/conditions suggest that these changes are not specific to an injury/condition. Bilateral sensorimotor changes have important implications with regards to the pathophysiology of musculoskeletal disorders of the wrist/hand, for rehabilitative interventions and research.

Spintronics, the use of spin of an electron instead of its charge, has received huge attention from research communities for different applications including memory, interconnects, logic implementation, neuromorphic computing, and many other applications. Here, in this paper, we review the works within spintronics, more specifically on spin-orbit torque (SOT) within different research groups. We also provide researchers an insight into the future potentials of the SOT-based designs. This comprehensive review paper covers different aspects of SOT-based design from device and circuit to architecture level as well as more ambitious and futuristic applications of such technology., Comment: 17 pages, 13 figures

Introduction: Umbrella shaped Perforated Screws (UPS) were developed for the use of orthopedic surgery to facilitate anchoring and fixation of the tissue to bone. We here present a retrospective study of Temporomandibular joint Internal derangement (ID) with fixation using this type of screws. Materials & Methods: We conducted a retrospective study including patients treated for ID using UPS to reposition the articular disc. The study included patients treated between 1998 and 2005. Patients were selected in concordance with clinical symptoms and signs of severity. All patients had an MRI (open/closed mouth) to confirm the diagnosis. Wilkes classification of temporomandibular disease (TMD) was adopted in the selection criteria. Results: Hundred and five patients were included, 92 female and 13 males with average age of 37.56. Dentists or general physicians mainly addressed these patients to our unit. The mean time from symptoms initiating to first consultation was 3.77 years, while the mean timing of surgery after initial consultation was 9.38 months. Patients have presented with various symptoms before the surgery including pain, limitation in eating habits and clicking. 77% of the patients had no or minimal pain post surgery. Hundred and one patients had good eating habits after surgery. Only 34 patients had persistent clicking despite surgery. We had neither infection nor hematoma as complication. Major complication to this technique is frontal paresis (14 patients), which was explained to all patients preoperatively. This paresis recovered in less than 2 months in all patients. We had 89.5% of the patients satisfied with their results. Conclusion: UPS are useful in the field of plastic surgery. This novel technique has the advantage of not compromising the vascular supply of the TMJ articular surface. This technique provides a simple, fast and efficient technique for posterior aponeurosis flap fixation. Our overall satisfactory rate was comparable to other studies.

Study Design Cross-sectional. Introduction Pain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. Purpose of the study The purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. Methods Measures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Results The best-fitting regression model with DASH scores entered as the dependent variable (F4,50 = 28.8, P Conclusion Pain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.

Summary Introduction Despite positive outcomes reported in the literature, some surgeons remain reluctant to the systematic use of venous couplers in free flap tissue transfer. In our institution, the use of the coupler devices for venous anastomosis in free flap breast reconstruction has yet to be adopted by all surgeons. The purpose of the study was to compare postoperative outcomes of coupler-assisted venous anastomoses with hand-sewn techniques in free flap breast reconstruction. Methods An analysis of collected data was performed on cases of breast reconstruction with free tissue transfer after mastectomy in breast cancer or BRCA-positive patients from 2010 to 2016. Patients were divided into two groups: coupler device and hand-sewn. The primary outcome was survival rate of free flaps. Secondary outcomes included potential complications, as well as surgical characteristics (recipient artery/vein, coupler size, type of hand-sewn anastomosis, size of sutures, number of venous anastomoses, ischemia time, operative time) Results We included 289 cases in our study. There were no significant differences between groups in terms of post-operative complications or survival rate of the free flaps. Ischemia time was significantly lower in both immediate and delayed reconstruction cases. Operative and anesthesia times were significantly lower only in immediate unilateral cases. Conclusion Although ischemia time was reduced in the coupler group, we didn’t find any significant difference in the operative and anesthesia time in the subgroup analysis, except for the group of immediate unilateral breast reconstruction. Couplers are safe and efficient; nevertheless, our study shows that their qualities cannot yet justify the disappearance of the manual sutures.

Clinical approach to surgical patients has evolved to include previous patients as part of the treating team in the role of "patient-advisors". Knowing that compliance to rehabilitation protocols is significant for a successful functional hand replantation, we set out to quantify functional patient-reported outcomes in individuals enrolled in a Patient-Advisor Program (PAP). We performed a prospective cohort pilot study of all patients admitted for a finger replantation between July 2015 to January 2016. All patients were offered to partake in the PAP, or else they would constitute the control group. Primary endpoints were functional outcomes as reported by patients at 6-8weeks and 4-6months of follow-up. Secondary endpoints were patient-reported pain and quality of life questionnaires. In total, 62 patients were admitted for finger replantation in the studied period, in which 50 agreed to participate in the study, including 7 in the patient-advisors group and 43 in the control group. Patients from the patient-advisors group fared better on mean scores of the Disabilities of the Arm, Shoulder and Hand than controls (29.6 vs 34.8 respectively at 4-6months). Improvements in the McGill Pain Questionnaire were also greater in the studied group (19.9 vs 33.3 at 4-6months). Replantation patients benefiting from the PAP demonstrated superior functional outcomes on self-reported questionnaires, which could be explained by a better understanding of rehabilitation protocols and compliance when previous patients are active members of the treating team.

Peripheral nerve research as well as nerve repair simulation has relied heavily on the rat animal model, more specifically on the rat sciatic nerve.1 As the use of animals in experiments and training has received much criticism from animal rights activists and society at large, the field of surgical simulation is currently emerging. In microsurgery, high-fidelity Silastic models, animal parts such as chicken thighs or wings, and cadaveric specimens have been used. Based on the available experience with Thiel embalmed cadaveric tissue in simulation,2–4 we experimented with Thiel embalmed peripheral nerves for the purpose of microsurgical skill training. We used median, ulnar, and tibial nerves from cadavers that had been used for anatomic and surgical training and had not touched the peripheral nerve tissue. The donors had previously consented to tissue utilization in postmortem research. The tissues originated from cadavers prepared with the embalming method described by Thiel.5 This technique preserves texture, volume, color, and shape of the body as perfect as possible, with the advantage of avoiding decay observed with fresh cadaveric specimens. There is no shrinking or soaking of the soft tissues. Thirteen nerve sections measuring 5 cm eachwere prepared on a foam board. Needles (25 G) are used to fix the nerves to the foam board. A blue background was used for the exercise, as it improves contrast. An operating microscope (Opmi Pico, Carl Zeiss, Oberkochen, German) at 10 magnification was used for all microneurorrhaphies. Under magnification, the nerves were crushed in the midsection to simulate an injured nerve. The participants transected the nerve using a 15-blade scalpel, and trimmed the damagednerve tissue. The two endswere inspected for the fascicular architecture and oriented appropriately for the repair. The epineurium was then gently reflected back and the proud fascicles trimmed. Nylon 8–0 sutures were used to perform a simple epineural repair, starting with the 0and 180-degree orientation sutures and then filling in the required sutures to obtain a well-oriented microneurorrhaphy. Under magnification of the operative microscope, we found the Thiel nerve tissue to show a slight gray-brown discoloration with an epineural layer that was hydrophilic, giving the impression of edematous tissue (►Fig. 1). This thicker-than-normal epineural layer, however, offers adequate support for manipulation. Unfortunately, the cadaveric nature of themodel precludes the use of the vasa nervorum,which are not visible, for adequate orientation of the nerve. Upon transection of the nerve, it can be observed that the fascicles arewell preserved and bound byfirm endoneurium and perineurium which have not undergone the same edema as the epineurium (►Fig. 1). Despite therebeing no immediate herniation of nerve fascicles upon transection, the fascicles have a tendency to bemorehygroscopic, and by the end of the neurorrhaphy, one can observe some protrusion of fascicles in between suture. The fascicular pattern is easily identifiable and permits good alignment of the nerve before suturing. Thirteen volunteer plastic surgery, otolaryngology, and orthopedics residents utilized themodel once each, andfilled out a postsimulation survey. The results were graded on a five-point Likert scale (strongly agree, disagree, neither agree nor disagree, agree, strongly agree). A question regarding the frequency participants would use the laboratory with answers graded in five categories was also asked. The contents of the postsimulation survey are presented in ►Table 1. Descriptive statistics are presented for the results of the survey questions. All participants (100.0%) agreed that they would use themodule at least twice a year,with 53.9% (seven residents) stating theywoulduse itmore than once amonth, 38.5% (five residents) once amonth, and7.7% (one resident) twice a year. The rapid development of microsurgery over the last three decades has been echoed by the development of several simulation models for the teaching and honing of microsurgical skills. Free flaps are routine procedures in most plastic surgery centers, and residents have ample opportunity to participate and perform in these procedures. As a

Summary Purpose To assess the utility of the Thiel arterial model in microsurgical research, we compared interrupted horizontal mattress (HM) sutures to simple interrupted (SI) sutures in human vessels. Methods A microsurgical set-up using an operating microscope and Thiel-embalmed arteries was used to practice ten SI and HM anastomoses. Vessel patency, leak and stricture were evaluated using angiography, and vessel wall architecture was evaluated using light microscopy and scanning electron microscopy (SEM). The technique speed was also assessed. Results We have successfully evaluated all outcomes. All anastomoses were patent. The stricture rate was higher with HM than with SI (60% vs. 35% surface area reduction). Three minor leaks occurred with HM sutures versus one with SI sutures. Edges were evenly everted without any intimal flaps with HM compared to SI. The anastomoses were performed faster using HM than SI sutures (7:58 min vs. 12:41 min, respectively). Conclusion This is the first study to evaluate the feasibility of a Thiel-embalmed artery model for research purposes. The HM microvascular suture is a promising technique that requires further in vivo validation.

Resume But de l’etude En 2007, l’OMS a cible l’evaluation des services chirurgicaux comme domaine necessitant des ameliorations en termes de securite chirurgicale. Une plateforme interactive de suivi chirurgical (PICS) a donc ete mise en place dans notre centre hospitalier comme outil d’analyse des reconstructions par lambeau libre. Une etude d’evaluation preliminaire a demontre que l’incidence de necrose totale des lambeaux libres etait de 10,0 % dans notre hopital, un taux parmi les plus eleves de la litterature. Le but de la plateforme vise la reduction des echecs a court terme des reconstructions par lambeaux libres. Patients et methodes A l’ete 2010, l’outil de capture et d’analyse des donnees (PICS) a ete mis en œuvre. Les patients ayant subi une reconstruction par lambeau libre ont ete prospectivement inclus dans la plateforme. Les criteres principaux (issues primaires) retenus pour evaluer l’efficacite de l’outil sont les taux de re-exploration chirurgicale et de necrose integrale des lambeaux. Resultats De mai 2010 a decembre 2011, 129 cas de reconstruction ont ete repertories. Le taux de necrose totale avant et apres l’introduction de PICS se chiffrent respectivement a 10,0 % et 3,1 % (p Conclusion L’implantation de PICS est associee a une amelioration des resultats postoperatoires a court terme des lambeaux libres. Cette plateforme est utile pour evaluer les services de soins et permet une securite chirurgicale accrue. Les equipes chirurgicales sont encouragees a mettre en place de tels outils de collectes et d’analyses afin d’evaluer les soins postoperatoires plus systematiquement et d’optimiser les pratiques cliniques.

Resume Depuis plusieurs dizaines d’annees les taux d’echec de la microchirurgie restent relativement constants. A l’aide de deux cas cliniques nous presentons une nouvelle possibilite de sauver des lambeaux microchirurgicaux par des interventions d’angioradiologie. Le premier cas montre les effets benefiques potentiels de la thrombolyse in situ, notre deuxieme cas decrit la premiere utilisation de stent au sein d’une anastomose microchirurgicale. Dans les deux cas, le lambeau aurait ete voue a l’echec immediat, car les tentatives de reprise s’etaient revelees infructueuses. Ainsi, avant de deposer un lambeau microchirurgical en apparence non fonctionnelle, la simple angiographie pourrait nous orienter vers cette nouvelle possibilite pouvant ainsi reduire a long terme le taux d’echec global de la microchirurgie.

Resume But de l’etude Le microscope electronique a balayage (MEB) est un vieil allie dans notre comprehension des interactions entre les biomateriaux que nous utilisons et le corps humain. Avec le MEB conventionnel (HiVac), les echantillons biologiques ne peuvent etre observes directement du fait de leurs fortes hydratations. Le but principal de cet article est de presenter les revolutions recentes en MEB, notamment le mode environnemental (ESEM). L’objectif secondaire sera de definir les interets potentiels de ces technologies dans l’analyse des capsules periprothetiques. Patientes et methode Il s’agit d’une etude prospective sur dix patientes atteintes de cancer du sein en cours de reconstruction par expanseurs-protheses. Lors de l’exerese de l’expanseur, un echantillon de capsule periprothetique a ete preleve. Chaque echantillon a ete examine en HiVac ainsi qu’en ESEM. Une analyse spectroscopie X a dispersion d’energie (EDX) a ete effectuee afin d’identifier les composants chimiques dans le tissu capsulaire. Pour chaque modalite, nous avons compare les informations concernant la texturation de la surface capsulaire, le decompte cellulaire et la presence d’un biofilm sur l’interface. Pour chaque image un score de 1 a 3 selon une echelle de Likert a ete attribue par trois experts en microscopie electronique independant. Resultats Le mode HiVac apparait superieur au mode ESEM concernant la definition de la texturation, l’identification des cellules et la presence d’un biofilm. L’analyse EDX permet dans les deux modes une analyse equivalente. Conclusion Le mode HiVac s’avere etre plus approprie que le mode ESEM dans l’analyse des capsules periprothetiques. L’analyse EDX permet de mettre en evidence des elements chimiques atypiques.

Summary Background Staged expander-to-implant breast reconstruction is plagued by a high prevalence of complications. We have employed an alternative approach of using the infra-mammary crease (IMF) for expander-to-implant exchange. The IMF approach was thought to utilize healthier tissues, which are believed to be less affected by the process of tissue expansion, and reside distant from the field of the radiotherapy boost. Methods A retrospective chart review was performed on all patients undergoing a staged implant-based breast reconstruction from 2009 to 2014. Patients were divided into those that received an IMF vs. a mastectomy scar (MS) approach in the second stage of expander-to-implant exchange. Patient characteristics and postoperative complications were extracted. Results A total of 75 patients undergoing 96-staged reconstructions were included (70 cases MS vs. 26 cases IMF). Patient demographics and implant characteristics were similar between groups. There were no significant differences in overall complications between the groups (11.4% MS vs. 7.7% IMF, P = 0.72). All cases of implant exposure occurred in the MS group and had a history of radiation. However, there was no statistical difference in implant exposure between groups (4.3% MS vs. 0% IMF, P = 0.56) or in the irradiated patients subgroup (20% MS vs. 0% IMF, P = 0.25). Conclusions In conclusion, the IMF approach for the second stage of expander-to-implant exchange is an alternative technique with a similar prevalence of complications as the traditional mastectomy scar approach. This technique may prove useful in reducing postoperative incisional dehiscence and implant exposure, especially in the context of radiotherapy.

The authors report the case of a 30-year-old male with 52% TBSA high-voltage electrical injury of the upper half of the body. Injuries included a cervical burn with associated alteration of the left brachial plexus as well as extensive soft tissue burn of the right hand. Three months later, he developed osteomyelitis of the right thumb metacarpal bone requiring amputation proximal to the metacarpophalangeal joint. Following initial management, the patient had a permanent distal left upper extremity paralysis with nonfunctional but relatively undamaged ipsilateral hand digits. The right hand remained functional with four intact digits and a thumb stump. Usually, late reconstruction of proximal thumb amputation is performed by pollicization or free toe transfer procedures. In this particular case, right thumb reconstruction was done by free transfer of the left little finger. Four months postoperatively, the patient demonstrated a functional pinch between the reconstructed thumb and the ipsilateral digits along with improving sensation. This uncommon surgical procedure restored a functional thumb with minimal donor site morbidity. The decision-making process and operative technique are presented in detail along with a review of the thumb reconstruction literature.

Resume Introduction La technique du ganglion sentinelle dans le melanome cutane est devenue une pratique courante. Son role est d’objectiver la presence de micrometastases dans le premier bassin ganglionnaire de drainage du site tumoral concerne. Ainsi, une stadification du melanome peut etre etablie. Toutefois, peu de travaux ont evalue la morbidite de cette procedure. Cette etude avait pour but de repertorier et d’analyser les complications liees a la technique du ganglion sentinelle chez les patients atteints de melanome cutane. Patients et methodes L’etude retrospective, monocentrique a inclus tous les patients ayant beneficie, entre 2001 et 2008, de l’exerese d’un ganglion sentinelle dont l’analyse histologique n’a pas montre d’envahissement ganglionnaire metastatique. Tous les patients porteurs d’un ganglion sentinelle envahi ont eu secondairement un curage ganglionnaire et, par consequent, ont ete exclus de l’etude. Ainsi, les complications du curage complementaire n’ont pas interfere avec celles du ganglion sentinelle. La duree moyenne de suivi a ete de 19 mois. Resultats Cent vingt-sept patients, dont 58 hommes et 69 femmes, ont ete inclus dans cette etude. Neuf patients (7,1 %) ont presente une complication. Nous avons constate sept complications precoces, survenant le premier mois (quatre seromes, une lymphorrhee, une infection avec retard de cicatrisation, une thrombose veineuse profonde) et deux complications tardives, survenant ensuite (un nevrome, une bride cicatricielle). Parmi ces neuf complications, quatre (44 %) ont concerne la region inguinale. Conclusion L’exerese du ganglion sentinelle est une technique chirurgicale qui semble simple et peu invasive, mais comme dans toute technique, des complications potentiellement graves peuvent survenir. Celles-ci doivent etre expliquees au patient dans le cadre de son information et de son consentement eclaire.