Conception et fabrication assistée par ordinateur de prothèses pour la correction des pectus excavatum

Le pectus excavatum est la malformation thoracique la plus fréquente. Son retentissement, comme ses indications chirurgicales, sont essentiellement morphologique et psychologique. La technique de comblement par prothèse de silicone sur mesure en position rétropectorale répond parfaitement aux exigences de cette chirurgie. Elle offre de bons résultats morphologiques au prix d'une intervention peu invasive dont les complications graves sont exceptionnelles. Cependant, la prise d'empreinte cutanée pour la confection de la prothèse est responsable de deux imperfections présentes à des degrés variables : la visibilité des bords de l'implant et l'aspect trop plat du plastron. Cela est dû à la méconnaissance de l'épaisseur des parties molles qui couvrent l'implant en post-opératoire. Notre étude, sur 7 cas, tente de prouver la supériorité de la conception-fabrication assistée par ordinateur des prothèses (CFAO), à partir de reconstructions tridimensionnelles du scanner thoracique des patients dans le plan chirurgical.Funnel chest is the most frequent congenital malformation of the anterior chest wall. Patients suffering from this deformity present morphologic and psychologic troubles, but exceptionally functional cardiopulmonary consequences, whathever the depth of the excavation. The surgical correction by a preformed silicone implant totally complies with the morphological requisites of this pathology. This non-invasive technique provides good results with rare complications. However, when the prosthesis is fabricated after a skin mould, the unpredictable soft tissue thickness leads to visible implant edges and a too flat chest wall on the midline. Our study, based on 7 cases, attempts to prove the superiority of Computer-Aided Design and Manufacturing (CAD/CAM) of the prosthesis. The principle is to design the implant based on surfacic tridimensional reconstruction of the surgical plane extracted from the patient's CT-sca.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Severe filamentous fungal infections after widespread tissue damage due to traumatic injury: Six cases and review of the literature.

International audienceWe describe 6 cases of severe filamentous fungal infections after widespread tissue damage due to traumatic injury in previously healthy people. Additionally, we report 69 cases from an exhaustive 20-y review of the literature to investigate the epidemiological and clinical features, the prognosis and the therapeutic management of these post-traumatic severe filamentous fungal infections. Traffic (41%) and farm accidents (25%) were the main causes of injury, which involved either the limbs only (41%) or multiple sites (41%). Necrosis was the main symptom (60%) and Mucorales (72%) and Aspergillus (11%) were the 2 most frequent fungi causing infection. These infections required substantial surgical debridement or amputation (96%) associated with aggressive antifungal therapy (81%), depending on the responsible fungi. This study underlines the need for early, repeated and systematic mycological wound samples to guide and adapt surgical and antifungal management in these filamentous fungal infections