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Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A retrospective study was conducted to assess the interactions between epileptic seizure and burn. The study was conducted on all patients treated at the Saint Luc Saint Joseph Hospital Burn Unit from 2000 to 2015 with a diagnosis of epilepsy. Forty-eight cases associating burns and epilepsy were reviewed. Twenty-eight patients had a burn following an epileptic seizure. The average age was 43, and the burned area was 9%. Injuries resulted from contact with hot surface (32%), scald burn (50% - 32% with cooking water and 17.8% by accidental exposure to hot tap water (shower)). Burns by flames were rare (4 cases/28: 14.3%). The burns were deep, and all required surgical treatment by excision - split thickness skin graft. All the cases of tap water burns occurred before 2010 and the changes to hot tap water temperature legislation. Three patients presented a new epileptic seizure during their hospitalization. Primary prevention of domestic accidents, particularly regulation of hot tap water temperature, appears effective. Educating epileptic patients on the importance of therapeutic compliance and the elimination of risky activities during periods of therapeutic modification should further reduce the incidence of seizure-related burns. [ABSTRACT FROM AUTHOR]

Introduction: Early focal brain injuries lead to long-term disabilities with frequent cognitive impairments, suggesting global dysfunction beyond the lesion. While plasticity of the immature brain promotes better learning, outcome variability across individuals is multifactorial. Males are more vulnerable to early injuries and neurodevelopmental disorders than females, but long-term sex differences in brain growth after an early focal lesion have not been described yet. With this MRI longitudinal morphometry study of brain development after a Neonatal Arterial Ischemic Stroke (NAIS), we searched for differences between males and females in the trajectories of ipsi- and contralesional gray matter growth in childhood and adolescence, while accounting for lesion characteristics., Methods: We relied on a longitudinal cohort (AVCnn) of patients with unilateral NAIS who underwent clinical and MRI assessments at ages 7 and 16 were compared to age-matched controls. Non-lesioned volumes of gray matter (hemispheres, lobes, regions, deep structures, cerebellum) were extracted from segmented T1 MRI images at 7 (Patients: 23 M, 16 F; Controls: 17 M, 18 F) and 16 (Patients: 18 M, 11 F; Controls: 16 M, 15 F). These volumes were analyzed using a Linear Mixed Model accounting for age, sex, and lesion characteristics., Results: Whole hemisphere volumes were reduced at both ages in patients compared to controls (gray matter volume: -16% in males, -10% in females). In ipsilesional hemisphere, cortical gray matter and thalamic volume losses (average -13%) mostly depended on lesion severity, suggesting diaschisis, with minimal effect of patient sex. In the contralesional hemisphere however, we consistently found sex differences in gray matter volumes, as only male volumes were smaller than in male controls (average -7.5%), mostly in territories mirroring the contralateral lesion. Females did not significantly deviate from the typical trajectories of female controls. Similar sex differences were found in both cerebellar hemispheres., Discussion: These results suggest sex-dependent growth trajectories after an early brain lesion with a contralesional growth deficit in males only. The similarity of patterns at ages 7 and 16 suggests that puberty has little effect on these trajectories, and that most of the deviation in males occurs in early childhood, in line with the well-described perinatal vulnerability of the male brain, and with no compensation thereafter., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Postic, Leprince, Brosset, Drutel, Peyric, Ben Abdallah, Bekha, Neumane, Duchesnay, Dinomais, Chevignard and Hertz-Pannier.)

Pseudomonas aeruginosa is one of the main causes of healthcare-associated infection in Europe that increases patient morbidity and mortality. Multi-resistant pathogens are a major public health issue in burn centers. Mortality increases when the initial antibiotic treatment is inappropriate, especially if the patient is infected with P. aeruginosa strains that are resistant to many antibiotics. Phage therapy is an emerging option to treat severe P. aeruginosa infections. It involves using natural viruses called bacteriophages, which have the ability to infect, replicate, and, theoretically, destroy the P. aeruginosa population in an infected patient. We report here the case of a severely burned patient who experienced relapsing ventilator-associated pneumonia associated with skin graft infection and bacteremia due to extensively drug-resistant P. aeruginosa . The patient was successfully treated with personalized nebulized and intravenous phage therapy in combination with immunostimulation (interferon-γ) and last-resort antimicrobial therapy (imipenem-relebactam).

Introduction: Chronic osteomyelitis is a serious osteoarticular infection that most often occurs in the long bones, responsible for significant morbidity with the risk of fracture and amputation. Despite advances in both antibiotics and surgical treatment, the probability of recurrence of infection remains at around 20%. Cerament-G (BONESUPPORT AB, Sweden) is a synthetic bone substitute that fills the bone void left by surgery, prevents infection and promotes bone regeneration within this space. Cerament-G also provides the local delivery of high doses of gentamicin over several weeks. Two prospective observational studies described a number of infectious recurrences of 4 and 5% after the use of Cerament-G. Although available in France, Cerament-G is currently not reimbursed and its high cost constitutes a barrier to its use. We hypothesize that the use of Cerament-G will lead to fewer costs to the collectivity while improving patient utility and, as an innovative strategy, will be superior to standard of care on recurrence of infection., Methods and Analysis: The Conviction Study is a prospective, multicenter, randomized, single blind study conducted in 14 French Reference Centers for Complex Osteoarticular infections. The main objective is to evaluate the cost-effectiveness of using Cerament-G in the treatment of chronic long bone osteomyelitis by comparing this innovative strategy to standard of care. A cost-utility analysis from the collective perspective will be conducted over a 24-month time horizon after the initial surgery. The outcome for the main medico-economic evaluation will be Quality Adjusted Life Years (QALYs)., Discussion: The study is being conducted throughout the CRIOAc network in France, in referral centers for the management of complex infections which will facilitate patient recruitment. This study has several limitations: the investigators have to be trained to handle the device, and it was impossible to blind the surgeon., Conclusion: If the use of Cerament-G is demonstrated to be superior to leaving the dead space empty during surgery for patients with stage III chronic long bone osteomyelitis, its use will be recommended to improve the prognosis of such patients, and this device may eventually qualify for reimbursement through the French Health Insurance scheme., Ethics and Dissemination: This protocol received authorization from the Ethics Committee CPP Sud Méditerranée V on April 27, 2021 (21.03.10.77652) and the French National Agency for Medicines and Health Products on May 6, 2021 (2020-A02299-30). Results will be disseminated to the scientific community through congresses and publication in peer-reviewed journals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Serrier, Huot, Brosset, Batailler, Ferry and on behalf of the Lyon BJI Study Group.)

Background: Reverse anterolateral thigh perforator (ALTp) pedicle flap can be used to reconstruct perigenicular defect thanks to the anastomoses between the descending branch of the lateral circumflex femoral artery (LCFA) and the perigenicular network. In a few cases, however, patients do not present any ALTp. We hypothesized that, in such cases, an adjacent perforator, the tensor fascia latae perforator (TFLp), emerging from the LCFA ascending branch, could be used instead. To assess the feasibility of this technique, a radiological study was conducted. A first patient was treated using this option., Methods: Sixty lower limb computed tomography were analyzed. The first treated patient was a 50-years-old man suffering from a 5-mm chronic bone exposure and osteomyelitis. Other reconstructive options were not indicated since he presented a multiscarry leg, severe arteriopathy, and no ALTp. A TFLp flap was raised, and the LCFA ascending and descending branches were dissected in continuity. After ligation of the LCFA, the blood flow reversed in the descending branch to irrigate the flap through the ascending branch., Results: A TFL perforator was observed in all the cases of the radiological study. The LCFA branching pattern was compatible with achieving a reverse TFL perforator flap in 43 cases (72%). The average pedicle length was 32 cm (22-38 cm). In the first clinical case, the flap covered the defect easily. After three months, the patient showed no evidence of infection recurrence and recovered a painless walk., Conclusion: The reverse TFLp flap can be a suitable option for perigenicular reconstruction., (© 2022 Wiley Periodicals LLC.)

Introduction: Mandibular angle resection is an important procedure in facial feminization surgery. Two different approaches are described: trans-oral and cervico-facial lift (CFL) approaches. The aim of the study was to compare surgical outcomes and patient's satisfaction between the two approaches., Material and Methods: We retrospectively analyzed medical charts of patients who underwent mandibular angle resection in the same center by the same surgeon between 2017 and 2019. Aesthetic and functional results were objectively assessed using serial photographs and subjectively with patient self-assessments. All patients benefited from a medical consultation at least 6 months after the surgery., Results: Seven patients benefited from trans-oral approach and 14 from CFL approach. The mean age was 42. No major complications occurred. No long-term nerve damage was found. Aesthetic evaluation showed mostly an improved result. All patients answered positively to the quality of life survey., Discussion: These preliminary results of the study suggest that mandibular angle resection is a much-needed and safe surgical procedure regardless of the surgical approach. Patients who underwent facial feminization surgery frequently present a mixed indication of CFL and mandibular angle resection. The study is limited by the low number of patients included. Moreover, interpretation of results is biased because the patients benefited from other minor facial cosmetic procedures in the same surgery. We reported the first analysis of transgender patient's satisfaction concerning mandibular angle resection. This procedure improves quality of life as well as facial aesthetics for transgender patients., (Copyright © 2021. Published by Elsevier Masson SAS.)

Intraoperative three-dimensional fabrication of living tissues could be the next biomedical revolution in patient treatment., Approach: We developed a surgery-ready robotic three-dimensional bioprinter and demonstrated that a bioprinting procedure using medical grade hydrogel could be performed using a 6-axis robotic arm in vivo for treating burn injuries., Results: We conducted a pilot swine animal study on a deep third-degree severe burn model. We observed that the use of cell-laden bioink as treatment substantially affects skin regeneration, producing in situ fibroblast growth factor and vascular endothelial growth factor, necessary for tissue regeneration and re-epidermalization of the wound., Conclusions: We described an animal study of intraoperative three-dimensional bioprinting living tissue. This emerging technology brings the first proof of in vivo skin printing feasibility using a surgery-ready robotic arm-based bioprinter. Our positive outcome in skin regeneration, joined with this procedure's feasibility, allow us to envision the possibility of using this innovative approach in a human clinical trial in the near future., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

In this paper, machine learning approaches are proposed to support dental researchers and clinicians to study the shape and position of dental crowns and roots, by implementing a Patient Specific Classification and Prediction tool that includes RootCanalSeg and DentalModelSeg algorithms and then merges the output of these tools for intraoral scanning and volumetric dental imaging. RootCanalSeg combines image processing and machine learning approaches to automatically segment the root canals of the lower and upper jaws from large datasets, providing clinical information on tooth long axis for orthodontics, endodontics, prosthodontic and restorative dentistry procedures. DentalModelSeg includes segmenting the teeth from the crown shape to provide clinical information on each individual tooth. The merging algorithm then allows users to integrate dental models for quantitative assessments. Precision in dentistry has been mainly driven by dental crown surface characteristics, but information on tooth root morphology and position is important for successful root canal preparation, pulp regeneration, planning of orthodontic movement, restorative and implant dentistry. In this paper we propose a patient specific classification and prediction of dental root canal and crown shape analysis workflow that employs image processing and machine learning methods to analyze crown surfaces, obtained by intraoral scanners, and three-dimensional volumetric images of the jaws and teeth root canals, obtained by cone beam computed tomography (CBCT).

In order to diagnose TMJ pathologies, we developed and tested a novel algorithm, MandSeg, that combines image processing and machine learning approaches for automatically segmenting the mandibular condyles and ramus. A deep neural network based on the U-Net architecture was trained for this task, using 109 cone-beam computed tomography (CBCT) scans. The ground truth label maps were manually segmented by clinicians. The U-Net takes 2D slices extracted from the 3D volumetric images. All the 3D scans were cropped depending on their size in order to keep only the mandibular region of interest. The same anatomic cropping region was used for every scan in the dataset. The scans were acquired at different centers with different resolutions. Therefore, we resized all scans to 512×512 in the pre-processing step where we also performed contrast adjustment as the original scans had low contrast. After the pre-processing, around 350 slices were extracted from each scan, and used to train the U-Net model. For the cross-validation, the dataset was divided into 10 folds. The training was performed with 60 epochs, a batch size of 8 and a learning rate of 2×10 -5 . The average performance of the models on the test set presented 0.95 ± 0.05 AUC, 0.93 ± 0.06 sensitivity, 0.9998 ± 0.0001 specificity, 0.9996 ± 0.0003 accuracy, and 0.91 ± 0.03 F1 score. This study findings suggest that fast and efficient CBCT image segmentation of the mandibular condyles and ramus from different clinical data sets and centers can be analyzed effectively. Future studies can now extract radiomic and imaging features as potentially relevant objective diagnostic criteria for TMJ pathologies, such as osteoarthritis (OA). The proposed segmentation will allow large datasets to be analyzed more efficiently for disease classification.

Introduction: Even if they represent only 2.5 % of the total body surface area, the hands are burnt in 50 % of hospitalized patients. The risk of sequelae is significant, especially in children, human being in full growth, and a source of aesthetic and functional handicap. The aim of this study is to research the predictive factors of sequelae, to study their treatment of and their evolution., Material and Methods: We included children under six years of age with deep palmar burns of the hand between 1998 and 2008. Demographics, characteristics of the initial burn and its treatment were noted. Then, we studied the types of hand burn sequelae and their treatment. Finally, we observed their evolution over time with an aesthetic and functional evaluation and their impact on quality of life., Results: Forty-nine children, representing 70 hands, were included in the study. The mean age at the time of the initial burn was 16.2 months (6; 60). The initial treatment was directed healing in 39 % of cases and thin skin excision-grafting in 61 % of cases. The type of sequelae most represented was bridle in 73 % of cases. Treatment consisted of rehabilitation measures (13 %) or surgery (69 %). The mean age at the time of surgery was 10.1 years (4; 19). These were plasties (62 %), total skin grafts (15 %) or a combination of both (23 %). The current follow-up is 16.2 years. The aesthetic result is considered good in 52 % of cases, the functional result is good in 78 % of cases. The impact on the quality of life is low and the parents are satisfied with the initial care., Conclusion: The treatment of the sequelae of burnt hands gives good results but involves well-conducted rehabilitation and regular monitoring. The treatment period must be adapted and the surgery simple, effective and specific to the type of sequelae., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Platelet rich plasma (PRP) has trophic functions due to a high concentration of growth factors and cytokines. These properties may be of therapeutic interest in the management of burn injuries. In preparation for a clinical study at the Lyon Burn Centre on PRP as an inducer of healing in burns, we carried out a review of the literature looking at the results of the use of this therapy. A review of the literature on the use of PRP for the treatment of burn injuries was performed by querying the PUBMED database using the keywords [platelet rich plasma] AND [burns]. Controlled clinical or pre-clinical studies in English or French were included. Eleven articles were identified, consisting of eight preclinical animal model studies and three clinical studies. These looked at the effects of PRP on the healing of burned areas whether they were grafted or not, on the improvement of neuropathic pain, and on distant skin trophicity. The results of recent preclinical studies show shorter epithelialization times thanks to PRP. In humans, a significant study (201 patients) validates its use in combination with thin skin grafts, and another shows benefits on distant cutaneous trophicity. In conclusion, the use of PRP topically or by injection under the skin has a potential benefit in the management of acute burns. A large-scale series validates its use in clinical practice., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)

Purpose: Many studies have shown the ability of low intensity pulsed ultrasound (LIPUS) to stimulate the bone, cartilage and tendon regeneration but only a few studied LIPUS interest in the regeneration of the oral mucosa. The purpose of this study is to assess the ability of LIPUS to stimulate the regeneration of the palatal mucosa in a porcine model., Methods: Ten adults mini-pigs were used. Two mucosal wounds were realised on the left and right side of the palate of each pig. The right side was treated with LIPUS at 1 MHz of frequency and 300 mW/cm2 of acoustic intensity. The left side was not treated. The morphology of the wound was evaluated using a polymer silicone molding., Results: The difference between two sides was significant from day 7 with a p value < 0.0001. At day 21, the wound is completely healed on all pigs with LIPUS. The control soft tissue defect exposed a healing of 80%., Conclusions: The present study showed that the use of LIPUS on the oral mucosa accelerates the healing of the masticatory mucosa.

In this paper, we present FlyBy CNN, a novel deep learning based approach for 3D shape segmentation. FlyByCNN consists of sampling the surface of the 3D object from different view points and extracting surface features such as the normal vectors. The generated 2D images are then analyzed via 2D convolutional neural networks such as RUNETs. We test our framework in a dental application for segmentation of intra-oral surfaces. The RUNET is trained for the segmentation task using image pairs of surface features and image labels as ground truth. The resulting labels from each segmented image are put back into the surface thanks to our sampling approach that generates 1-1 correspondence of image pixels and triangles in the surface model. The segmentation task achieved an accuracy of 0.9.

The Data Storage for Computation and Integration (DSCI) proposes management innovations for web-based secure data storage, algorithms deployment, and task execution. Its architecture allows inclusion of plugins for upload, browsing, sharing, and task execution in remote computing grids. Here, we demonstrate the DSCI implementation and the deployment of Image processing tools (TMJSeg), machine learning algorithms (MandSeg, DentalModelSeg), and advanced statistical packages (Multivariate Functional Shape Data Analysis, MFSDA), with data transfer and task execution handled by the clusterpost plug-in. Due to its comprehensive web-based design, local software installation is no longer required. The DSCI aims to enable and maintain a distributed computing and collaboration environment across multi-site clinical centers for the data processing of multisource features such as clinical, biological markers, volumetric images, and 3D surface models, with particular emphasis on analytics for temporomandibular joint osteoarthritis (TMJ OA).

This paper proposes machine learning approaches to support dentistry researchers in the context of integrating imaging modalities to analyze the morphology of tooth crowns and roots. One of the challenges to jointly analyze crowns and roots with precision is that two different image modalities are needed. Precision in dentistry is mainly driven by dental crown surfaces characteristics, but information on tooth root shape and position is of great value for successful root canal preparation, pulp regeneration, planning of orthodontic movement, restorative and implant dentistry. An innovative approach is to use image processing and machine learning to combine crown surfaces, obtained by intraoral scanners, with three dimensional volumetric images of the jaws and teeth root canals, obtained by cone beam computed tomography. In this paper, we propose a patient specific classification of dental root canal and crown shape analysis workflow that is widely applicable.

Facial feminization surgery brings a set of surgical procedures that address the three thirds of the face and aims to give feminine characteristics to a masculine face. The characteristics of the lower third of a male face are a long, broad chin, a prominent mandible with sharp angles (in connection with the insertions of the masseter muscles). Mandibular angle reduction is an important procedure of the male-to-female transformation. It allows to modify the appearance of the lower third of the face, reducing the bi-mandibular distance in the coronal plane and opening the mandibular angle in profile. The classical procedure uses trans-oral surgical approach. However, patients undergoing male-to-female sexual transformation frequently present a mixed indication of cervicofacial lift and angular resection. We present an innovative surgical technique associating cervicofacial lifting and mandibular angle resection using the same cutaneous surgical approach. We describe its advantages and discuss its disadvantages., (Copyright © 2019. Published by Elsevier Masson SAS.)

Temporomandibular joints (TMJ) like a hinge connect the jawbone to the skull. TMJ disorders could cause pain in the jaw joint and the muscles controlling jaw movement. However, the disease cannot be diagnosed until it becomes symptomatic. It has been shown that bone resorption at the condyle articular surface is already evident at initial diagnosis of TMJ Osteoarthritis (OA). Therefore, analyzing the bone structure will facilitate the disease diagnosis. The important step towards this analysis is the condyle segmentation. This article deals with a method to automatically segment the temporomandibular joint condyle out of cone beam CT (CBCT) scans. In the proposed method we denoise images and apply 3D active contour and morphological operations to segment the condyle. The experimental results show that the proposed method yields the Dice score of 0.9461 with the standards deviation of 0.0888 when it is applied on CBCT images of 95 patients. This segmentation will allow large datasets to be analyzed more efficiently towards data sciences and machine learning approaches for disease classification.

Background: Within the framework of mammary reconstruction, since 2012 when Allen first described it, the profunda femoral artery perforator flap (PAP) takes an important place in the current therapeutic options., Objective: This anatomical study aims to analyze the anatomy and morphologic consideration of the PAP : position of the perforating artery; length of the pedicle, area and volume of vascularization., Methods: Sixteen flaps were harvested on fresh subjects at the University Department of Anatomy of Rockfeller, Lyon. The first direct cutaneous branch from the deep femoral vessels was located between or through the adductor magnus and gracilis muscles. Pedicle location, diameter, length and position regard to the great saphenous vein were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area and volume of cutaneous territory supplied by the studied perforator., Results: On the 16 analyzed flaps, localization of the perforating artery is on average to 8.2cm of the pubic tuber and 3.7cm behind a line connecting the pubic tuber to the internal femoral condyle. The length of the pedicle is on average of 11.7cm and the average area of skin perfused was 94,68cm 2 . The way of this perforating arterty is primarily through the adductor magnus. On the radiological images of the 8 flaps, the analysis shows an average surface of 111,25cm 2 and a mean volume of 325.3cm 3 ., Discussion: PAP is an interesting therapeutic choice within the framework of a mammary reconstruction. Its surface and its volume associated with a discrete scar make a valid indication within the framework of this surgery., (Copyright © 2019. Published by Elsevier Masson SAS.)

Mucormycosis are infrequent filamentous fungal infections, but severe and with high mortality (20 to 50%). Symptoms are very common, like necrosis, and burn/polytrauma patients have a higher risk of mucormycosis than the general population. We report here the history of a 38-year-old man, polytraumatized and burned because of a tractor incident. During the first two weeks two haemorrhagic shock episodes occurred because of necrosis of the humeral artery. Analysis of vascular fragment identified Lichteimia spp. The diagnosis of invasive infection was established after identifying Lichteimia spp. in blood cultures also. We treated the patient with intravenous liposomal amphotericin, oral posaconazole and surgical debridement according to the gold standard. The wound mucormycosis was also treated with a humeral bypass with vascular allograft and a latissimus dorsi pedicled flap. Furthermore, mucormycosis was treated with local instillations of amphotericin B in the dressings twice a day with 1% (1 mg/100mL) solution of non-liposomal amphotericin. Early diagnosis and treatment is very important for mucormycosis healing and to minimize morbimortality. With burn and polytrauma patients necrosis and bad local evolution have to be carefully screened and analyzed., (Copyright © 2020 Euro-Mediterranean Council for Burns and Fire Disasters.)

Purpose: With constraints and a risk of complication, tissue expansion in child's burn sequelae need a controlled surgical procedure, and a therapeutic plan appropriate to the specific pediatric healing, growth, and development., Material and Methods: Our principles of management and technical points are described. A retrospective study of tissue expansion in child's burn sequelae between 2005 and 2016 is submitted., Results: There are 185 expanders, 98 protocols in 41 children, over half of sequelae concerning scalp, neck and chest. Mean age at the first expansion was 10.3 years old (5.8 years after burn). There are in average 2,4 (1-8) protocols by patient, with 1.9 (1-4) expanders by procedure. Surgical repair was a flap (78.8%), a full-thickness skin graft (13.3%) or both. Fifteen patients (30 expanders (14.6%) and 22 protocols (22.4%)), had expansion's complications, mostly infections and expositions. Eight patients (14 expanders (7.6%) and 10 protocols (10.2%)) had reconstructive's complications. An increase of burn area was a risk factor of complication (significant). Complicated expanders rate by location was 7.9% (scalp), 12.5% (neck), 9.8% (supraclavicular), 10.5% (chest), 19.4% (abdomen), 30% (buttock), 29.4% (lower limb), 1/2 (face)., Conclusion: Tissue expansion in child's burn sequelae is ideal in scalp, good in neck, chest and proximal upper limb, and to do carefully in lower limb and face., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of history of surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This third original article will focus on the inventors of modern scissors: Mayo, Metzenbaum, Stevens and Lister., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of History of Surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This second original article will focus on the inventors of modern retractors: von Langenbeck, Farabeuf, Leriche, Gillies and Tessier., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Autologous breast reconstruction by means of microsurgical abdominal flaps is an very well described technique. The flap harvest dissection under inguinal ligament would cause the risk of parietal weakening in this zone and postoperative bulging. The goal of our study is to investigate whether the deep inferior epigastric artery diameter remains constant from its exit of the external iliac artery to its entrance in the rectus muscle sheath., Patients and Method: One hundred arteries were studied on fifty preoperative computed tomographic angiographies made before a DIEAP flap for breast reconstruction. We measured the caliber of the left and right deep inferior epigastric arteries at these two landmarks. The length of this artery between these was also calculated. This data were collected with specific angiography reconstruction., Results: At the caudal landmark, the mean DIEA diameter was 2.1±0.27mm on the left side and 2.1±0.31mm on the right side. At the cephalic landmark, the mean DIEA diameter was 2.0±0.28mm on the left and 2.0±0.27mm on the right side (P=0.00035 at left side; P=0.0089 at right side). The mean pedicle length between the two landmarks was 22.3±2.85mm on the left side and 22.2±2.98mm on the right side., Conclusion: This computed tomographic angiography study showed that the diameter of DIEA is equivalent at its origin and at the lateral border of muscle. Flap harvest without dissection under inguinal ligament provides sufficient pedicle length and caliber to allow for comfortable and reliable sutures., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: PJI is the most dramatic complication after joint arthroplasty. In patients with chronic infection, prosthesis exchange is in theory the rule. However, this surgical approach is sometimes not desirable especially in elderly patients with multiple comorbidities, as it could be associated with a dramatic loss of function, reduction of the bone stock, fracture, or peroperative death. We propose here to report different approaches that can help to maintain the function in such patients based on a pathophysiology-, multidisciplinary-, and an experience-based approach., Methods: We describe the different points that are needed to treat such patients: (i) the multidisciplinary care management; (ii) understanding the mechanism of bacterial persistence; (iii) optimization of the conservative surgical approach; (iv) use of suppressive antimicrobial therapy (SAT); (v) implementation of innovative agents that could be used locally to target the biofilm., Results: In France, a nation-wide network called CRIOAc has been created and funded by the French Health ministry to manage complex bone and joint infection. Based on the understanding of the complex pathophysiology of PJI, it seems to be feasible to propose conservative surgical treatment such as "debridement antibiotics and implant retention" (with or without soft-tissue coverage) followed by SAT to control the disease progression. Finally, there is a rational for the use of particular agents that have the ability to target the bacteria embedded in biofilm such as bacteriophages and phage lysins., Discussion: This multistep approach is probably a key determinant to propose innovative management in patients with complex PJI, to improve the outcome., Conclusion: Conservative treatment has a high potential in patients with chronic PJI for whom explantation is not desirable. The next step will be to evaluate such practices in nation-wide clinical trials., (© The Authors, published by EDP Sciences, 2020.)