From rigid bone plate fixation to stable dynamic osteosynthesis in mandibular and craniomaxillo-facial surgery: Historical evolution of concepts and technical developments

International audienc

Repair of gauge earlobe medium defect

International audienceDefects due to earlobe gauging are becoming more and more frequent. Many techniques have been described to repair major defects but very few papers exist about medium defects. The aim of this article is to describe a simple surgical technique to repair medium deformations, based on two opposite crescents on the anterior and posterior sides of the earlobe. It gives a harmonious result to the overall shape of the earlobes with a natural curve along the inferior border which is the most difficult part of this surgery

Identification par HPLC-ESI-MS d’un extrait d’aiguille de Juniperus oxycedrus subsp oxycedrus obtenu par extraction par soxhlet

International audienc

An ex ante analysis of the economic profitability of automatic oestrus detection devices in different dairy farming systems in France

The reproductive performance of dairy herds is mainly influenced by the physiological reproductive status of the cows and by herd management. The objective of this work was to evaluate the economic benefits of investment in a sensor system for oestrus detection (pedometer or activity meter) in different dairy farming systems in France. A stochastic dynamic model was used to simulate all the physiological and management processes occurring in a dairy operation. Seven French dairy farms with different breeds (Holstein, Montbéliarde and Normande), size (30 to 119 cows), milk price (conventional or protected designation of origin) and calving strategies (grouped or continuous calving) were simulated. Six scenarios with different oestrus detection rates (50% before and 90% after use of the equipment) and percentage of cows equipped (40%-80%-100%) were applied to each farm. The internal rate of return was used to evaluate the economic benefits of the investment. It was estimated that the system for transmitting and analysing data from pedometer and activity meter systems would cost €6,498 and €4,430 respectively. The use of an automatic oestrus detection device reduced the calving interval by between 7d (herds with Normande cows) and 23d (herds with Holstein cows) and increased the annual gross margin per cow by between €8 (small herd with Normande cows) and €92 (herd with Montbéliarde cows). The investment appeared profitable in two-thirds of the situations, characterised by high milk prices, large herd size or low percentage of cows equipped. These results suggest that the return on investment should be estimated at each farm level

Technique de prélèvement d’un lambeau perforant thoracodorsal : mise au point

International audienceLe lambeau perforant thoracodorsal (TDAP) est une méthode de reconstruction fiable dont les indications n’ont cessé d’augmenter ces dernières années. Plusieurs variantes chirurgicales existent et différentes techniques de prélèvement ont été décrites. Cependant, face à une dissection parfois complexe et chronophage du pédicule, l’utilisation fréquente de cette méthode de couverture nous a amené à adapter la technique de prélèvement de ce lambeau. L’objectif de cette étude descriptive est d’établir une mise au point quant à la méthode de dissection du pédicule du lambeau perforant thoracodorsal. La préservation du réseau nerveux et la préservation d’une collerette musculaire sur un diamètre de deux centimètres à l’entrée du pédicule dans le muscle en sont les points clefs.The thoracodorsal artery perforator (TDAP) flap is a reliable method of reconstruction by which the indications were on a constant rise during the last few years. Several surgical variants exist and different harvesting techniques were described. However, with our experience using this flap for substance-loss coverage, we frequently faced a complex and relatively time-consuming pedicle dissection. This brought us to adapt our harvesting technique according to the anatomical situations of the neighboring structures. The purpose of this study is to revisit and adapt the method of the pedicle dissection for the TDAP flap. The conservation of both the nervous network and a section of a circumferential muscular collar with a diameter of two centimeters are the main keys of our study

Le potentiel antioxydant de Haloxylon articulatum et l’identification de l’extrait actif par LC-ESI-Mn

International audienc

Traitement radical de la maladie de Verneuil : comparaison de l’utilisation du derme artificiel et des lambeaux perforants pédiculés

International audienceObjectivesThe objective of this study was to compare the use of artificial dermal and perforator flap after radical surgery of severe axillary and perineal hidradenitis suppurativa disease.Patients and methodsThe data on postoperative outcomes, scar assessment (POSAS) and quality of life (DLQI, SF-36) were collected during consultation or by phone call. Forty-seven patients were included in our study between January 2015 and September 2017, including 27 patients in the artificial dermal group and 20 patients in the perforator flap group.ResultsThe quality of life assessment by the SF-36 questionnaire showed a significant increase in quality of life in both groups (P < 0.05), higher in the perforating flap group (P < 0.001). The DLQI questionnaire showed a decrease in the impact of MV on quality of life in both groups, which was greater in the perforator flap group (P < 0.05). The scarring assessment by the POSAS patient and observer questionnaire showed a better overall opinion in the perforator flap group (P < 0.001). In the perforator flap group, the total hospital stay and healing time was shorter (P < 0.001) and the return to work was faster (P < 0.001).ConclusionThe artificial dermis and the perforator flaps are very useful coverage solutions after radical surgery of hidradenitis suppurativa. The use of perforator flaps, however, seems more interesting while simplifying the post-operative course.ObjectifsL’objectif de cette étude était de comparer les stratégies de couverture par derme artificiel et par lambeau perforant en hélice après chirurgie radicale de maladie de Verneuil (MV) évoluée au niveau axillaire et périnéal.Patients et méthodesLes données concernant les suites opératoires, le résultat (POSAS) et la qualité de vie (DLQI, SF-36) ont été recueillies en consultation ou par téléphone. Quarante-sept patients ont été inclus dans l’étude entre janvier 2015 et septembre 2017, dont 27 patients dans le groupe derme artificiel et 20 patients dans le groupe lambeau perforant.RésultatsL’évaluation de la qualité de vie par le questionnaire SF-36 a montré une augmentation significative de la qualité de vie dans les deux groupes (p < 0,05), supérieure dans le groupe lambeau perforant (p < 0,001). Le questionnaire DLQI a montré une diminution de l’impact de la MV sur la qualité de vie dans les deux groupes, plus importante dans le groupe lambeau perforant (p < 0,05). L’évaluation cicatricielle par le questionnaire POSAS patient et observateur a montré une meilleure opinion globale dans le groupe lambeau perforant (p < 0,001). Dans le groupe lambeau perforant, la durée d’hospitalisation complète et le délai de cicatrisation était plus courts, (p < 0,001) et la reprise de l’activité professionnelle était plus rapide (p < 0,001).ConclusionLe derme artificiel et les lambeaux perforants sont des solutions très utiles dans la couverture de chirurgie radicale de maladie de Verneuil. L’utilisation des lambeaux perforants semble cependant plus intéressante tout en simplifiant les suites opératoires

Propeller Perforator Flaps of Extremities Seem Less Reliable

International audienc

The trapezius perforator flap: Versatility for locoregional reconstruction

International audienceOnly a few surgical choices are available for cervical and thoracic spine coverage. The trapezius perforator flap is relatively unknown and only a few authors have published on this subject. In this article, we report on four clinical cases where a trapezius perforator flap was used either as a propeller flap, as a tunnelized island flap, or as a supercharged flap for cervical spine, thoracic spine and anterior cervical defects. Harvesting this flap is quite simple and enables high quality reconstruction with low donor-site morbidity in complex situations

Lower limb perforator flaps: Current concept.

International audienceFollowing a long period dominated by random fasciocutaneous flaps or muscle flaps, solutions to cover the lower limb have been largely diversified by the advent of so-called "perforator" flaps. Extended knowledge of vascular anatomy has propagated the development of this innovative procedure, in the objective of reducing morbidity. The existence of close to 400 perforator vessels in the body makes it possible to offer new flap perspectives for many defects, which were sometimes previously impossible to manage before except by free flap. For us, perforator flaps have become the current first-line solutions for small to medium size loss of substances. Understanding of vascular physiology and surgical experience are essential in choosing indications, detecting perforators, and modeling flaps to be optimally positioned in the reconstructive decisional algorithm. New skills are needed to master this type of reconstruction and limit failures, which implies a learning curve not only for flap design, perforator detection and surgical procedure, but also for monitoring and management of complications. In this manuscript, we outline the concepts and principles of the majority of the pedicled perforator flaps available for coverage of the lower limb, based on experience of more than 400 perforator flaps suitable for this localization