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Abstract Background Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases. Results Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90–92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents. Conclusions Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.

Ten to fifty percent of high-risk cutaneous squamous cell carcinoma may potentially metastasize. However, the concept of sentinel lymph node biopsy remains controversial for cutaneous squamous cell carcinoma. The aim of this study was to identify prognostic factors associated with sentinel lymph node positivity. A bicentric retrospective analysis was conducted between January 2006 and January 2018. All patients undergoing sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma were included, based on the criteria of the prognostic classification of the French Society of Dermatology. Seventy-four patients were included. Five (6.8%) procedures failed. Of the 69 patients assessed, the positive sentinel lymph node biopsy rate was 11.6% (n = 8) with a false negative rate of 5.7% (n = 4). The positivity of sentinel lymph node biopsy was associated with tumour size (p = 0.0194). Sentinel lymph node biopsy is an effective staging procedure for clinically N0 high-risk cutaneous squamous cell carcinoma, with an acceptable morbidity. To date, 2 risk factors of sentinel lymph node positivity have been identified with statistical significance: tumour size and poor tumour differentiation.

PurposeThe gold-standard for reconstruction of large mandibular defects is the use of free flaps of vascularized autologous bone with the fibula as the preferred donor site. The use of "custom cutting guides" for this indication is becoming increasingly prevalent. But cost of the procedure averages around 2,500 dollars per patient excluding treatment and entails selection criteria. We think it is possible to standardize mandibular reconstructions from an anatomical mean. The objective of this study was to perform a mandibular morphometric analysis in order to obtain a set of "mean" measurements, which can be used by all surgeons interested in mandibular reconstruction.MethodsWe performed a morphometric analysis consisting of three-dimensional mandibular reconstructions of 30 men and 30 women. Several reference points were set and defined to evaluate specific lengths and angles of interest. We conducted an intra and inter-sexual descriptive analysis of measurements obtained.ResultsWe did not identify any major intra-sexual differences within each group. The gonial angle is more open in women and the measurements characterizing the basilar contour are more prominent in men. We did not identify any differences in alveolar region parameters.ConclusionThe results of this study constitute a morphological tool for surgeons, from bone graft to free flap. These results also confirm us that the use of «custom cutting guides» for mandibular reconstruction may be excessive. It is pertinent to examine the value of "custom made" mandibular reconstructions since the differences observed are of the order of millimeters.

Cefoxitin is a beta-lactam antibiotic belonging to the cephamycins class, up to now only used in clinical practice for prophylaxis during surgery. Recently, its use has increased due to the spread of infections caused by extended-spectrum beta-lactamase-producing bacteria, particularly urinary tract infections. It has a broad antimicrobial spectrum and is also effective in polymicrobial bone and joint infections or skin and soft tissue infections. Stability data allows its use as a continuous infusion in intensive care units or with elastomeric diffuser for outpatients. Cefoxitin is well tolerated. The aim of this article was to highlight the interesting aspects of this old and inexpensive intravenous beta-lactam.