Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

Purpose: In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible. Methods: This was a retrospective case-control study on patients hospitalized from 2004 to 2009. Results: We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of tendays. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was threedays and the median delay between trauma and surgery was oneday. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome. Conclusion: We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis

Infections profondes des tissus mous

The clinical presentations of deep soft tissue infections can, initially, mimicry superficial skin infections such as erysipelas. However, a rapidly deteriorating health status, the spreading of the lesions and the lack of clear visual limitation of the infection on the skin are hallmarks of a more severe underlying infection, which may endanger patients' life. An immediate adequate multidisciplinary approach to therapy within a few hours is mandatory. The first step is surgical exploration with debridement of all infected tissues, accompanied by antibiotic therapy and additional supportive measures. Despite progress in the understanding of the physiopathology, the delay between suspicion of diagnosis and surgical exploration remains critical. Because of the low incidence of such severe infections, only multicenter studies might reveal deeper insights of optimal therapeutic strategies in the future and for possible improved patients' survival

Techniques de reconstruction mammaire et indications dans la prise en charge des femmes à haut risque

Grâce à l'évolution des connaissances oncologiques et chirurgicales, la chirurgie d'exérèse est devenue de moins en moins invasive et différentes techniques de reconstruction mammaire sont aujourd'hui proposées aux patientes : prothèse, lambeau ou transfert de graisse autologue. Le choix de la technique doit être adapté à chaque patiente, particulièrement chez les patientes jeunes à haut risque, candidates à une reconstruction bilatérale simultanée ou différée. Il est reconnu que la reconstruction mammaire permet d'améliorer significativement l'image de soi, la qualité de vie et le confort des patientes qui ont dû subir une intervention oncologique. Chaque femme, et en particulier la jeune femme à haut risque, doit avoir la possibilité d'en bénéficier et de préférence dans le même temps opératoire que le traitement oncologique (reconstruction immédiate). Afin d'offrir la reconstruction mammaire à un plus grand nombre de patientes, une collaboration multidisciplinaire entre les différents intervenants (sénologue, oncologue, chirurgien plastique) est primordiale. Elle facilite notamment l'accès de la jeune patiente à l'information indispensable concernant les possibilités et options de reconstruction

Breast Reconstruction: A Century of Controversies and Progress

Breast cancer treatment has dramatically changed over the past century. Since Halsted's first description of radical mastectomy in 1882, breast reconstruction has evolved slowly from being considered as a useless or even dangerous procedure by surgeons to the possibility nowadays of reconstructing almost any kind of defect. In this review on the development of breast reconstruction, we outline the historical milestone innovations that led to the current management of the mastectomy defect in an attempt to understand the economic, social and psychological factors, which contributed to slow down its acceptance for several decades

Routine chest X-ray is not mandatory after fluoroscopy-guided totally implantable venous access device insertion

The aim of this study is to determine whether systematic postoperative chest X-ray is required after totally implantable venous access port device (TIVAD) placement under fluoroscopic control

Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible