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Barry L, Guerre E, Jeanne M, Pasquesoone L. [The Place of Groin, Colson and McGregor Flaps in the Acute Care of Deep Burns to the Hand Dorsum : A Series of 6 Cases In Lille's Burn Centre]. Ann Burns Fire Disasters 2024; 37:64-78. [PMID: 38680834 PMCID: PMC11041980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 05/01/2024]
Abstract
The acute management of deep burns to the dorsum of the hand and fingers represents a challenge for the reconstructive surgeon. The exposure of osteo-tendinous structures often requires flap coverage, in a context where loco-regional or free flaps are not always feasible. The aims of reconstruction are to preserve a maximum of digital length, provide supple tissue, obtain protective sensitivity, and achieve a functional hand at 1 year. We report here on a series of 8 deep burns to the dorsum of the hand. Six hands were covered by Colson abdominal flap-graft and two by pedicled inguinal flap. Four out of 6 patients were reviewed in consultation, 1 patient was lost to follow-up, and 1 patient died. Clinical evaluation was performed by a surgeon other than the operator. Functional results are highly variable. Coverage time varies according to lesion depth and patient severity. Flap weaning took place at an average of 30 days. DASH scores ranged from 17.5 to 93/100, with average to poor total active motion (TAM) scores. The aesthetic result was satisfactory, with a Vancouver score of 4.5/13 on average, and an overall patient opinion of 3.75/10 on the POSAS scale. For deep burns to the dorsum of the hand and fingers, local flaps are rarely possible, and loco-regional flaps are not feasible in cases of associated upper limb damage. For medium to large surface areas, pedicled inguinal flaps and pocketing are two reliable techniques. Nevertheless, they require relative immobilization of the upper limb, which leads to stiffness. The question of digital pinning in the intrinsic or straight position remains unresolved, and does not appear to prevent secondary deformities. There is also a learning curve for these two flaps, even though they are reputed to be easy to lift. McGregor's flap or pocketing can be weighed against free flaps. However, the operating time is long, the surgical technique is complex, and vascular damage is common in the burn patient population. Although there have been enormous technical advances since their descriptions, the pedicled inguinal flap and pocketing remain alternatives to be considered in the acute management of deep burns to the dorsum of the hand. In this presentation, we propose a surgical management algorithm to situate these two techniques in the plastic surgeon's therapeutic armament.
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Affiliation(s)
- L. Barry
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, Hôpital Salengro, CHU de Lille, France
- Centre de Traitement des Brûlés, Hôpital Salengro, CHU de Lille, France
| | - E. Guerre
- Polyclinique de Keraudren, Brest, France
| | - M. Jeanne
- Centre de Traitement des Brûlés, Hôpital Salengro, CHU de Lille, France
| | - L. Pasquesoone
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, Hôpital Salengro, CHU de Lille, France
- Centre de Traitement des Brûlés, Hôpital Salengro, CHU de Lille, France
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Lacroix G, Jeanne M, Martinot V, Pasquesoone L. "Extensive necrosis following extravasation of alkali in the crease of the elbow after voluntary intravenous injection: A case report". ANN CHIR PLAST ESTH 2023; 68:81-85. [PMID: 35902288 DOI: 10.1016/j.anplas.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
Chemical burns are often deep with difficult initial clinical evaluation, especially those due to alkalic agents, which have a strong penetrating power. They therefore require specialized care in a Burn Unit. Self-inflicted burns are infrequent but their management represents a real challenge. We report the case of a 47-year-old referred to our Burn Center for the evaluation of a self-inflicted corrosion with an alkalic agent (soda), injected at the crease of the left elbow. The patient, right handed, was a nurse and had notably a psychiatric history of depressive syndrome. We observed a deep, well-defined necrosis area, associated with intense peri-lesional inflammation and extensive cellulitis. Faced with this unusual clinical appearance for a chemical burn, the patient's questioning was repeated and the patient finally admitted to having injected himself with a basic caustic product intravenously. Surgical treatment was carried out in two stages: debridement with exposure of vascular and neural structures then coverage with a free anterolateral thigh flap. The postoperative consequences were uneventful with a satisfactory functional result. Factitious disorders are underestimated and often misleading. Among factitious disorders, self-inflicted wounds remain a real challenge requiring multidisciplinary management. Many etiologies exist, among which injection of drugs or substances, in any anatomical localization, leading to variable loss of substance. The use of a free flap for acute extravasation is rare but sometimes essential. The anterolateral thigh flap allows good resurfacing on areas with important functional requirements.
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Affiliation(s)
- G Lacroix
- Plastic Surgery and Burn Centre, CHU de Lille, 59000 Lille, France.
| | - M Jeanne
- Anesthesia and Critical Care, Burn Centre, CHU de Lille, 59000 Lille, France; Inserm, CIC 1403 - centre d'investigations cliniques, University of Lille, 59000 Lille, France; ULR 7365, GRITA - groupe de recherche sur les formes injectables et les technologies associées, University of Lille, 59000 Lille, France
| | - V Martinot
- Plastic Surgery and Burn Centre, CHU de Lille, 59000 Lille, France
| | - L Pasquesoone
- Plastic Surgery and Burn Centre, CHU de Lille, 59000 Lille, France
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Ngô B, Barry L, Bonte A, Belkhou A, Calibre C, Pasquesoone L, Guerreschi P, Duquennoy-Martinot V. [Gynécomastia. Management of diagnosis and therapy. Apropos of 148 cases]. ANN CHIR PLAST ESTH 2022; 67:382-392. [PMID: 36058764 DOI: 10.1016/j.anplas.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Gynecomastia is the most frequently breast lesion in males. 148 patients (mean age 24,7 years) operated in our department were reviewed with a mean follow-up of five years. Gynecomastia occurred most frequently during puberty (77,7 %), was bilateral (86,5%) and idiopathic (89,9%). The size of the enlargement was evaluated according to Simon's-classification based on breast-volume and skin-redundancy. 17 (11,5%) stage 1, 77 (52%) stage 2A, 32 (21,6%) stage 2B, 22 (14,9%) stage 3. Clinical examination and mammography determined the consistency of gynecomastia: adipose or firm. 4 different surgical managements were used: 17 (11,5%) subcutaneous mastectomies, 4 (2,7%) liposuctions, 110 (74,3%) liposuctions associated with subcutaneous mastectomy, 17 (11,5%) total mastectomy. All techniques gave good morphologic results. Nonetheless, the authors recommend the combination «liposuction and subcutaneous mastectomy», as this technique presents many advantages: small intraoperative blood loss, good skin redraping, short hospital stay, complete histologic examination of the material removed.
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Affiliation(s)
- B Ngô
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France.
| | - L Barry
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France
| | - A Bonte
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France
| | - A Belkhou
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France
| | - C Calibre
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France
| | - L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile Laine, 59037 Lille Cedex, France
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Lacroix G, Martinot-Duquennoy V, Ngo B, Knipper P, Pasquesoone L. [Not Available]. Ann Burns Fire Disasters 2022; 35:152-159. [PMID: 36381338 PMCID: PMC9416691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/10/2021] [Indexed: 06/16/2023]
Abstract
Armenia and Azerbaijan fought between September and November 2020 in Nagorno-Karabagh. Several surgical missions were scheduled by Assistance Publique- Hôpitaux de Paris to help care for the warinjured Armenians. These missions included the evaluation of Armenian soldiers suspected of having been injured by phosphorus. Facing, during these missions, such infrequent burns, we were interested in their pathophysiology, care and complications. Repeated up-to-date information is necessary in order to better take care of phosphorus burns. Therefore, we conducted a literature review, using PubMed and the Mesh Terms "phosphorus" and "burns", without setting any date limit. The review acknowledges that phosphorus burns are deep, tend to spread and may be the cause of systemic toxicity including hypocalcaemia, which can lead to heart rate disturbance and even death. In the acute phase, burns should be extensively washed with normal saline or water before a mechanical decontamination. One should not use oily dressings, given the liposolubility of phosphorus. Subsequently, one or many debridements are necessary before starting wound coverage, for which any kind of plastic surgery may be used. Phosphorus burns are infrequent but serious. They mainly occur in warfare and should be known by any caregiver acting in this context.
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Affiliation(s)
- G. Lacroix
- Centre de Traitement des Brûlés, CHRU Lille, Université Lille 2, France
| | | | - B. Ngo
- Centre de Traitement des Brûlés, CHRU Lille, Université Lille 2, France
| | - P. Knipper
- Service de Chirurgie Plastique Ambulatoire, Hôpital Cochin - Port Royal, Assistance Publique - Hôpitaux de Paris, Université de Paris, Fran
| | - L. Pasquesoone
- Centre de Traitement des Brûlés, CHRU Lille, Université Lille 2, France
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Defurne A, Duquennoy-Martinot V, Jeanne M, Pasquesoone L. Engelures Liées À L’Usage Festif De Protoxyde D’Azote. Cas Clinique Et Revue De La Littérature. Ann Burns Fire Disasters 2021; 34:319-322. [PMID: 35035324 PMCID: PMC8717912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 06/14/2023]
Abstract
The recreational consumption of nitrous oxide has steadily increased in recent years. Before being inhaled, the nitrous oxide is contained in a gas cylinder held firmly between the thighs and then the gas is transferred to a rubber balloon. During the deconditioning steps, the cylinder cools down and causes frostbite. We report the case of six third-degree burns on the inner side of the thighs. At first superficial, this burn will deepen and require surgical management.
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Affiliation(s)
- A. Defurne
- Centre de Traitements des Brûlés, Hôpital Roger Salengro, Lille, France
| | - V. Duquennoy-Martinot
- Centre de Traitements des Brûlés, Hôpital Roger Salengro, Lille, France
- Service de Chirurgie Plastique, Hôpital Roger Salengro, Lille, France
| | - M. Jeanne
- Centre de Traitements des Brûlés, Hôpital Roger Salengro, Lille, France
| | - L. Pasquesoone
- Centre de Traitements des Brûlés, Hôpital Roger Salengro, Lille, France
- Service de Chirurgie Plastique, Hôpital Roger Salengro, Lille, France
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Knipper P, Bégué T, Pasquesoone L, Guerre E, Khonsari R, Girard P, Berger A, Khachatryan L, Tchaparian M. [Plastic surgery and fighting: Our experience during Nagorno-Karabakh war in 2020]. ANN CHIR PLAST ESTH 2021; 66:201-209. [PMID: 33966906 DOI: 10.1016/j.anplas.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This work relates the experience of three French surgical missions in the care of the war wounded during the armed conflict in Nagorno Karabakh which took place from September 27 to November 10, 2020. MATERIALS AND METHODS Three surgical missions were carried out in Armenia between October 2020 and January 2021. Surgeons intervened in different hospitals, at different times of the conflict and on various war wounds. RESULTS The presence of a plastic surgeon proved to be essential in the care of war wounded, especially in delayed emergency and secondary care. The ortho-plastic treatment offered during these missions has proven to be effective in the reconstruction of limbs. These missions made it possible to introduce the induced membrane technique of Masquelet AC in Armenia. During our visit to the Yerevan burn center, we mentioned the very probable use of white phosphorus as an etiology in several of the cases analyzed. CONCLUSION We relate the particular experience of civilian surgeons in the context of a modern armed conflict. The presence of a plastic surgeon proved to be indispensable in the care of war wounded and especially in their secondary reconstructions.
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Affiliation(s)
- P Knipper
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - T Bégué
- Service de chirurgie orthopédique, traumatologique et réparatrice, hôpital Antoine-Béclère, AP-HP, université Paris-Saclay, 157, rue de la Porte-de-Triviaux, 92140 Clamart, France
| | - L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, avenue Émile-Laine, 59037 Lille, France
| | - E Guerre
- Service de chirurgie orthopédique, hôpital Roger-Salengro, avenue Émile-Laine, 59037 Lille, France
| | - R Khonsari
- Service de chirurgie maxillo-faciale et chirurgie plastique, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - P Girard
- Service de chirurgie orthopédique et traumatologique, groupe hospitalier public du sud de l'Oise, site de Creil, boulevard Laennec, 60100 Creil, France
| | - A Berger
- Service de chirurgie digestive et obésité, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - L Khachatryan
- Service de chirurgie vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Tchaparian
- Service de traumatologie, hôpital Roger-Salengro, avenue Émile-Laine, 59037 Lille, France
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Chevalier T, Pasquesoone L, Guerreschi P, Duquennoy-Martinot V. [Violence against women through burns, about two cases]. ANN CHIR PLAST ESTH 2021; 66:273-275. [PMID: 33824026 DOI: 10.1016/j.anplas.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- T Chevalier
- Service de chirurgie plastique, reconstructrice et esthétique, Centre de traitement des brûlés, Hôpital Salengro, Centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | - L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, Centre de traitement des brûlés, Hôpital Salengro, Centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, Centre de traitement des brûlés, Hôpital Salengro, Centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, Centre de traitement des brûlés, Hôpital Salengro, Centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
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Pasquesoone L, Barry L, Sturbois-Nachef N, Duquennoy-Martinot V, Chantelot C, Guerre E. The interest of "ortho-plastic" collaboration in management of complex limb injury. ANN CHIR PLAST ESTH 2020; 65:423-446. [PMID: 32654841 DOI: 10.1016/j.anplas.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 01/26/2023]
Abstract
Constantly evolving knowledge on fracture management, soft tissue coverage, microsurgery and vasculo-nervous repair now permits salvage of limbs that previously would have had to be amputated. Management of complex limb injuries of which the severity inevitably entails functional and esthetic sequelae calls for mastery of the full spectrum of bone and soft tissue reconstruction. Such mastery is rarely attainable by a single surgical specialty; individually and isolatedly, an orthopedic or plastic surgeon cannot ensure optimal management of the above-mentioned patients. While the orthopedist performs a key function in provisional or definitive fixation, the plastic surgeon's expertise is essential to restoration of the cutaneous envelope. Collaboration between the two specialties from the outset and throughout treatment characterizes the modern-day concept of "ortho-plastic" surgery. Through unification of the theoretical competence and practical skills of orthopedists and plastic surgeons, it provides a patient with the best possible functional and esthetic results in a wide range of clinical situations. In this article, we present a review of the literature illustrating the interest of "ortho-plastic" collaboration in management of complex limb injury; concrete examples will be given through evocation of clinical cases encountered by the team that was put together in August 2015 at the university hospital (CHU) of Lille.
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Affiliation(s)
- L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, Centre de traitement des brûlés, CHU, Hôpital Roger-Salengro, avenue Emile-Laine, 59037 Lille, France.
| | - L Barry
- Service de chirurgie plastique, reconstructrice et esthétique, Centre de traitement des brûlés, CHU, Hôpital Roger-Salengro, avenue Emile-Laine, 59037 Lille, France
| | - N Sturbois-Nachef
- Service d'orthopédie B, CHU Lille, Hôpital Roger-Salengro, avenue Emile-Laine, 59037 Lille, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, Centre de traitement des brûlés, CHU, Hôpital Roger-Salengro, avenue Emile-Laine, 59037 Lille, France
| | - C Chantelot
- Service de traumatologie, CHU Lille, Hôpital Roger-Salengro, avenue Emile-Laine, 59037 Lille, France
| | - E Guerre
- Service d'orthopédie B, CHU Lille, Hôpital Roger-Salengro, avenue Emile-Laine, 59037 Lille, France
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Chauvineau V, Pasquesoone L, Le Floch R. [Not Available]. Ann Burns Fire Disasters 2019; 32:321-330. [PMID: 32431583 PMCID: PMC7197910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 06/11/2023]
Abstract
This congress shared 3 main topics: inflammation - especially in the rehabilitation phase, fires and smoke inhalation, and flaps in sequelae. The first is reported by Valérie Chauvineau, the second by Ronan Le Floch and the third by Louise Pasquesoone.
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Affiliation(s)
- V. Chauvineau
- Service de Réhabilitation des Brûlés, Hôpital Léon Bérard, Hyères, France
| | - L. Pasquesoone
- Centre de Traitement des Brûlés, Hôpital Roger Salengro, Lille, France
| | - R. Le Floch
- Réanimation Chirurgicale et des Brûlés, CHU Nantes, Nantes, France
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Devinck F, Deveaux C, Bennis Y, Deken-Delannoy V, Jeanne M, Martinot-Duquennoy V, Guerreschi P, Pasquesoone L. [Deep alkali burns: Evaluation of a two-step surgical strategy]. ANN CHIR PLAST ESTH 2018; 63:191-196. [PMID: 29653673 DOI: 10.1016/j.anplas.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/16/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision. RESULTS Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059). CONCLUSION Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure.
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Affiliation(s)
- F Devinck
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France.
| | - C Deveaux
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - Y Bennis
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - V Deken-Delannoy
- EA 2694-santé publique : épidémiologie et qualité des soins, CHU de Lille, université de Lille, 59000 Lille, France
| | - M Jeanne
- Pôle d'anesthésie réanimation, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - V Martinot-Duquennoy
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
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Fréalle E, Rocchi S, Bacus M, Bachelet H, Pasquesoone L, Tavernier B, Mathieu D, Millon L, Jeanne M. Real-time polymerase chain reaction detection of Lichtheimia species in bandages associated with cutaneous mucormycosis in burn patients. J Hosp Infect 2018; 99:68-74. [PMID: 29432820 DOI: 10.1016/j.jhin.2018.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cutaneous mucormycoses, mainly due to Lichtheimia (Absidia), have occurred on several occasions in the Burn Unit of the University Hospital of Lille, France. AIM To investigate the potential vector role of non-sterile bandages used to hold in place sterile gauze used for wound dressing. METHODS Mycological analysis by conventional culture, Mucorales real-time polymerase chain reaction (qPCR), and Lichtheimia species-specific qPCR were performed on eight crepe and six elasticized bandages that were sampled on two independent occasions in March 2014 and July 2016. Characteristics of the seven Lichtheimia mucormycoses which occurred in burn patients between November 2013 and July 2016 were also collected to assess the epidemiological relationship between potentially contaminated bandages and clinical infections. FINDINGS One Lichtheimia corymbifera strain was isolated from a crepe bandage by culture, and Lichtheimia spp. qPCR was positive in six out of eight crepe and four out of six elasticized bandages. Using species-specific qPCR, Lichtheimia ramosa, Lichtheimia ornata, and L. corymbifera were identified in six out of ten, five out of ten, and four out of ten bandages, respectively. In patients with mucormycosis, L. ramosa and L. ornata were present in five and two cases, respectively. CONCLUSION Our data support the utility of Mucorales qPCR for epidemiological investigations, the potential role of these bandages in cutaneous mucormycoses in burn patients in our centre, and, consequently, the need for sterile bandages for the dressing of extensive wounds.
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Affiliation(s)
- E Fréalle
- Université de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CNRS, UMR 8204, F-59000 Lille, France; Inserm, U1019, F-59000 Lille, France; CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France.
| | - S Rocchi
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Laboratoire de Parasitologie-Mycologie, CHU de Besançon, France
| | - M Bacus
- CHU Lille, Pôle d'Anesthésie-Réanimation, Centre de Traitement des Brûlés, F-59000 Lille, France
| | - H Bachelet
- CHU Lille, Pharmacie Centrale, F-59000 Lille, France
| | - L Pasquesoone
- CHU Lille, Service de chirurgie plastique, esthétique et reconstructrice - Centre de Traitement des Brûlés, F-59000 Lille, France
| | - B Tavernier
- CHU Lille, Pôle d'Anesthésie-Réanimation, Centre de Traitement des Brûlés, F-59000 Lille, France
| | - D Mathieu
- CHU Lille, Pôle de Réanimation, F-59000 Lille, France
| | - L Millon
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Laboratoire de Parasitologie-Mycologie, CHU de Besançon, France
| | - M Jeanne
- CHU Lille, Pôle d'Anesthésie-Réanimation, Centre de Traitement des Brûlés, F-59000 Lille, France
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12
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Pasquesoone L, Belkhou A, Gottrand L, Guerreschi P, Duquennoy-Martinot V. [Management of purpura fulminans lesions in children]. ANN CHIR PLAST ESTH 2016; 61:605-612. [PMID: 27289551 DOI: 10.1016/j.anplas.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
Purpura fulminans is a pediatric life-threatening emergency with a significant mortality, combining: septic shock, extensive purpuric lesions and disseminated intravascular coagulation. The most frequent bacterial pathogen is the meningococcus. The medical management includes antibiotics, corticoids, vascular filling and catecholamines. Purpura fulminans is characterized by the extent of hemorrhagic and mainly thrombotic lesions, attributed to the alteration in the vascular endothelium functions. Damage of soft tissues combines large necrotic areas and more or less extensive distal ischemic lesions. Necrotic lesions can be deep, reaching skin, subcutaneous tissue, fascia, muscle and sometimes even the bone. The importance of the aesthetic and functional sequelae as well as future quality of life, depend on the quality of surgical management for these wide and deep lesions. Fasciotomy is sometimes urgently needed in the case of a clinical compartment syndrome, confirmed by a high-pressure measurement in the muscle compartments. Debridement of necrotic lesions and amputations are only performed after a clear delineation of necrotic areas, between 10 days and 3 weeks of evolution. If an amputation is necessary, it must focus on the residual bone length, considering the child's growth potential. The coverage of tissue loss uses all the plastic surgery techniques, more or less complex, in order to reduce scars to minimum for these children. Rehabilitation follow-up includes physical and psychological care, which are essential until adulthood.
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Affiliation(s)
- L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.
| | - A Belkhou
- Clinique de chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - L Gottrand
- Centre de rééducation Marc-Sautelet, 10, rue du Petit-Boulevard, 59650 Villeneuve-d'Ascq, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France
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13
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Pasquesoone L, Aljudaibi N, Ellart J, Guerreschi P, Duquennoy-Martinot V. [Emergency management of extravasation in children]. ANN CHIR PLAST ESTH 2016; 61:598-604. [PMID: 27614718 DOI: 10.1016/j.anplas.2016.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
The subcutaneous diffusion of intravenous drips, or extravasation, is a frequent iatrogenic complication in children, mainly in the neonatal period. This potentially severe pathology can lead to local ischemia that sometimes mimics compartment syndrome. It can also evolve towards vast soft-tissue necrosis. Nursing staff often underestimate the risk of functional, aesthetic, and psychological consequences. The speed and quality of the initial medical and surgical management can greatly decrease morbidity associated with extravasation. Prevention is fundamental, such as raising awareness in and training medical and paramedical staffs and creating efficient protocols. Surgical management involving aspiration and washing the site as early as possible improves the prognosis. Aspiration and washing can be done on a larger area if one criteria of severity is met, particularly in cases of extravasation using a vesicant or hyperosmolar agent. If necrotic lesions appear, it is wise to wait until they become delimited. Debridement and coverage can be performed using classical methods.
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Affiliation(s)
- L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France.
| | - N Aljudaibi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
| | - J Ellart
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
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Duquennoy-Martinot V, Belkhou A, Pasquesoone L, Depoortère C, Guerreschi P. [Scar revision in children: Clinical situations and solutions]. ANN CHIR PLAST ESTH 2016; 61:578-588. [PMID: 27346752 DOI: 10.1016/j.anplas.2016.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 05/11/2016] [Indexed: 12/15/2022]
Abstract
The scar of soft tissues is a permanent stigma of a trauma but it can sometimes be improved. It is more or less accepted by the patient and may be the source of a significant physical and psychosocial impact that leads to a request for a scar revision. Even if the child presents generally an excellent ability to heal, the quality of the scar depends on many factors such as the age, the type of scar or trauma and the affected body area. Thus, its aesthetic impact, functional but also on the growth of the child will be different. Moreover, these scars have a number of origins: neonatal surgery, natural history of congenital lesions or after a surgical management; surgeries for orthopedic, cardiac, craniofacial or hand birth defects and congenital malformations; or infectious or traumatic as in the case of burns and animal bites. We have many ways to try to correct or improve these scars, which use all the plastic surgery techniques. However, we need to establish for each case an appropriate management strategy with the objective of not inducing additional sequelae, respecting the growth of the child. Several techniques can be combined and the chronology of the surgical procedures must consider the school, social and family integration of the child.
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Affiliation(s)
- V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHRU Lille, rue Emile-Laine, 59037 Lille cedex, France
| | - A Belkhou
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHRU Lille, rue Emile-Laine, 59037 Lille cedex, France.
| | - L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHRU Lille, rue Emile-Laine, 59037 Lille cedex, France
| | - C Depoortère
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHRU Lille, rue Emile-Laine, 59037 Lille cedex, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHRU Lille, rue Emile-Laine, 59037 Lille cedex, France
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Alsharari M, Pasquesoone L, Khater R, Guerreschi P, De Broucker V, Martinot-Duquennoy V. Necrotizing soft tissue infections following a scald burn of the lower limb: a case report. Ann Burns Fire Disasters 2013; 26:158-61. [PMID: 24563643 PMCID: PMC3917152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Indexed: 06/03/2023]
Abstract
Necrotizing soft tissue infection (NSTI) is a rare but potentially fatal infection. It usually complicates skin traumas, such as lacerations, scratches, insect bites, burns and recent surgeries. Rapid diagnosis is crucial for a favourable prognosis. NSTI is an emergency surgical condition and every delay in the operative treatment has a proven negative effect. Recently, a rare case presented to us with a late diagnosis of NSTI complicating a scald burn of the lower limb. The patient's injury was initially treated as a burn case but unfortunately ended in an above knee amputation. We report our management experience in this case, with a review of the literature.
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Affiliation(s)
- M. Alsharari
- Department of Plastic Reconstructive and Aesthetic Surgery and Burn Centre, Faculty of Medicine, University of Lille 2, Lille, France
| | - L. Pasquesoone
- Department of Plastic Reconstructive and Aesthetic Surgery and Burn Centre, Faculty of Medicine, University of Lille 2, Lille, France
| | - R. Khater
- Department of Plastic Reconstructive and Aesthetic Surgery and Burn Centre, Faculty of Medicine, University of Lille 2, Lille, France
| | - P. Guerreschi
- Department of Plastic Reconstructive and Aesthetic Surgery and Burn Centre, Faculty of Medicine, University of Lille 2, Lille, France
| | - V. De Broucker
- Department of Plastic Reconstructive and Aesthetic Surgery and Burn Centre, Faculty of Medicine, University of Lille 2, Lille, France
| | - V. Martinot-Duquennoy
- Department of Plastic Reconstructive and Aesthetic Surgery and Burn Centre, Faculty of Medicine, University of Lille 2, Lille, France
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Duquennoy-Martinot V, Guerreschi P, Pasquesoone L. Chirurgie esthétique du sein chez l'enfant et l'adolescente. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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