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Hornez E, Cotte J, Thomas G, Prat N, Vauchaussade de Chaumont A, Daban JL, Boddaert G, Pasquier P, Castel F, Mahe P, Balandraud P. Ultra-forward surgical support for special operations forces. Conception, development and certification of the French Special Operations Surgical Team (SOST) airborne capability. Injury 2024; 55:111002. [PMID: 37633765 DOI: 10.1016/j.injury.2023.111002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/11/2023] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
When special operations forces (SOF) are in action, a surgical team (SOST) is usually ground deployed as close as possible to the combat area, to try and provide surgical support within the golden hour. The French SOST is composed of 6 people: 2 surgeons, 1 scrub nurse, 1 anaesthetist, 1 anesthetic nurse and 1 SOF paramedic. It can be deployed in 45 min under a tent or in a building. However, some tactical situations prevent the ground deployment. A solution is to deploy the SOST in a tactical unprepared aircraft hold, to make it possible to offer DCS, to treat non-compressible exsanguinating trauma, without any ground logistical footprint. This article describes the stages of the design, development and certification process of the airborne SOST capability. The authors report the modifications and adaptations of the equipment and the surgical paradigms which make it possible to solve the constraints linked to the aeronautical and combat environment. Study type/level of evidence Care management Level of Evidence IV.
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Affiliation(s)
- Emmanuel Hornez
- Digestive surgery, Percy Military teaching hospital, 1 rue Raoul Batany, 92140, Clamart, France; École du Val-de-Grâce, French Military Medical Service Academy, Paris, France.
| | - Jean Cotte
- Intensive care unit, Sainte Anne Military teaching hospital, Toulon, France
| | - Gil Thomas
- 1 CSS/FS, French Military Medical Service, Villacoublay, France
| | - Nicolas Prat
- French Military Biomedical Research Institute, bretigny, France; École du Val-de-Grâce, French Military Medical Service Academy, Paris, France
| | | | - Jean Louis Daban
- Intensive care unit, Percy Military teaching hospital, 1 rue Raoul Batany, 92140, Clamart, France
| | - Guillaume Boddaert
- Thoracic surgery, Percy Military teaching hospital, 1 rue Raoul Batany, 92140, Clamart, France; École du Val-de-Grâce, French Military Medical Service Academy, Paris, France
| | - Pierre Pasquier
- 1 CSS/FS, French Military Medical Service, Villacoublay, France; École du Val-de-Grâce, French Military Medical Service Academy, Paris, France
| | - Fabrice Castel
- 1 CSS/FS, French Military Medical Service, Villacoublay, France
| | - Pierre Mahe
- 1 CSS/FS, French Military Medical Service, Villacoublay, France
| | - Paul Balandraud
- Digestive surgery, Sainte Anne Military teaching hospital, Toulon, France; École du Val-de-Grâce, French Military Medical Service Academy, Paris, France
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Fischer J, Barbois S, Quesada JL, Boddaert G, Haen P, Bertani A, Duhamel P, Delmas JM, Lechevallier E, Piolat C, Rongieras F, Tresallet C, Balandraud P, Arvieux C. Early Evaluation of a New French Surgery Course in the Best Practice of Dealing With Major Incidents and Mass Casualty Events. J Surg Educ 2023; 80:1253-1267. [PMID: 37429782 DOI: 10.1016/j.jsurg.2023.06.011] [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] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The main objective of this study is to evaluate the impact of a nationwide 5-month course aimed to prepare surgeons for Major Incidents through the acquisition of key knowledge and competencies. Learners' satisfaction was also measured as a secondary objective. DESIGN This course was evaluated thanks to various teaching efficacy metrics, mainly based on Kirkpatrick's hierarchy in medical education. Gain in knowledge of participants was evaluated by multiple-choice tests. Self-reported confidence was measured with 2 detailed pre and post training questionnaires. SETTING Creation in 2020 of a nationwide, optional and comprehensive Surgical Training in War and Disaster Situation as part of the French surgery residency program. In 2021, data was gathered regarding the impact of the course on participants' knowledge and competencies. PARTICIPANTS The study included 26 students in the 2021 cohort (13 residents and 13 practitioners). RESULTS Mean scores were significantly higher in the post-test compared to the pre-test, showing significant increase in participants' knowledge during the course: 73,3% vs. 47,3% respectively (p ≤ 0.001). Average learners' confidence scores to perform technical procedures showed at least a +1-point increase on the Likert scale for 65% of items tested (p ≤ 0.001). 89% of items showed at least a +1-point increase on the Likert scale when it came to average learners' confidence score on dealing with complicated situations (p ≤ 0.001). Our post-training satisfaction survey showed that 92% of all participants have noticed the impact of the course on their daily practice. CONCLUSION Our study shows that the third level of Kirkpatrick's hierarchy in medical education was reached. This course therefore appears to be meeting the objectives set by the Ministry of Health. Being only 2 years old, it is on the road to gathering momentum and further development.
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Affiliation(s)
- Juliette Fischer
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.
| | - Sandrine Barbois
- Inria, CNRS, Grenoble INP, LJK, University Grenoble Alpes, Grenoble, France; Department Of Digestive and Acute Care Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 university, Lyon, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Academic Hospital, Clamart Cedex, France
| | - Pierre Haen
- Department of Maxillofacial Surgery, Laveran Military and Academic Hospital, Marseille, France
| | - Antoine Bertani
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Patrick Duhamel
- Department of Plastic surgery, Percy Military Academic Hospital, Clamart, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Academic Hospital, Clamart, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, AP-HM, Conception Academic Hospital, Marseille, France
| | - Christian Piolat
- Department of Paediatric surgery, Grenoble Alpes University Hospital, Grenoble , France
| | - Frédéric Rongieras
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, APHP, Avicenne Academic Hospital, Sorbonne Paris Nord University, Bobigny France
| | - Paul Balandraud
- Department of General Surgery, Sainte-Anne Military Academic Hospital, Toulon, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
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Cobianchi L, Dal Mas F, Agnoletti V, Ansaloni L, Biffl W, Butturini G, Campostrini S, Catena F, Denicolai S, Fugazzola P, Martellucci J, Massaro M, Previtali P, Ruta F, Venturi A, Woltz S, Kaafarani HM, Loftus TJ, Aapoäÿlu R, Abbott KL, Abdelmalik A, Abebe NS, Abu-Zidan F, Adam YAY, Adamou H, Adamovich DM, Agresta F, Agrusa A, Akin E, Alessiani M, Alexandrino H, Bidoli C, Ali SM, Mihai VA, Almeida PM, Al-Shehari MM, Altomare M, Amico F, Ammendola M, Andreuccetti J, Anestiadou E, Annicchiarico A, Antonelli A, Aparicio-Sanchez D, Ardito A, Argenio G, Arvieux CC, Arvieux C, Askevold IH, Atanasov BT, Augustin G, Awad SS, Bacchiocchi G, Bagnoli C, Bahouth H, Baili E, Bains L, Baiocchi GL, Bala M, Balaguà© C, Balalis D, Baldini E, Baraket O, Baral S, Barone M, Gonzãlez Barranquero A, Barreras JA, Bass GA, Bayhan Z, Bellanova G, Ben-Ishay O, Bert F, Bianchi V, Biancuzzi H, Radulescu RB, Bignell MB, Biloslavo A, Bini R, Bissacco D, Boati P, Boddaert G, Bogdanic B, Bombardini C, Bonavina L, Bonomo L, Bottari A, Bouliaris K, Brachini G, Brillantino A, Brisinda G, Bulanauca MM, Buonomo LA, Burcharth J, Buscemi S, Calabretto F, Calini G, Calu V, Campanile FC, Campo Dall’Orto R, Campos-Serra A, Carvas JM, Cascella M, Pattacini GC, Celentano V, Centonze DC, Ceresoli M, Chatzipetris D, Chessa A, Chiarello MM, Chirica M, Chooklin S, Chouliaras C, Chowdhury S, Cianci P, Cillara N, Cimbanassi S, Cioffi SPB, Colãis-Ruiz E, Colak E, Conti L, Coppola A, de Sa TC, Costa SD, Cozza V, Curro’ G, Dabekaussen KFASA, D’acapito F, Damaskos D, D’Ambrosio G, Das K, Davies RJ, de Beaux AC, De Lebrusant Fernandez SP, De Luca A, De Simone B, De Stefano F, Degrate L, Demetrashvili Z, Demetriades AK, Detanac DS, Dezi A, Di Buono G, Carlo IDI, Di Lascio P, Di Martino M, Di Saverio S, Diaconescu B, Diaz JJ, Dibra R, Dimitrov EN, Dinuzzi VP, Dios-Barbeito S, Diyani JFA, Dogjani A, Domanin M, D’Oria M, Munoz-Cruzado VD, East B, Ekelund M, Ekwen GT, Elbaih AH, Elhadi M, Enninghorst N, Ernisova M, Escalera-Antezana JP, Esposito S, Esposito G, Estaire-Gãmez M, Farã CN, Farre R, Favi F, Ferrario L, Ferrario di Tor Vajana A, Filisetti C, Fleres F, Fonseca VC, Forero-Torres A, Forfori F, Fortuna L, Fradelos E, Fraga GP, Fransvea P, Frassini S, Frazzetta G, Frigerio I, Frountzas M, Gachabayov M, Galeiras R, Garcãa BM, Garcia Vazquez A, Gargarella S, Garzali IU, Ghannam WM, Ghazi FN, Gillman LM, Gioco R, Giordano A, Giordano L, Giove C, Giraudo G, Giuffrida M, Capponi MG, Gois E, Gomes CA, Gomes FC, Gonsaga RAT, Gonullu E, Goosen J, Goranovic T, Gracia-Roman R, Graziano GMP, Griffiths EA, Guagni T, Hadzhiev DB, Haidar MG, Hamid HKS, Hardcastle TC, Hayati F, Healey AJ, Hecker A, Hecker M, Garcia EFH, hodonou AM, huaman EC, Huerta M, Ibrahim AF, Ibrahim BMS, Ietto G, Inama M, Ioannidis O, Isik A, Ismail N, Ismail AMH, Jailani RUHIF, Jang JY, Kalfountzos C, Kalipershad SNR, Kaouras E, Kaplan LJ, Kara Y, Karamagioli E, Karamarkovia A, Katsaros I, Kavalakat AJ, Kechagias A, Kenig J, Kessel BJ, Khan JS, Khokha V, Kim JI, Kirkpatrick AW, Klappenbach R, Kobe Y, Lymperis EK, Kok KYY, Kong V, Korkolis DP, Koukoulis G, Kovacevic B, Kruger VF, Kryvoruchko IA, Kurihara H, Kuriyama A, Landaluce-Olavarria A, Lapolla P, Licari L, Lisi G, Litvin A, Lizarazu A, Bayo HL, Lohsiriwat V, Moreira CCL, Lostoridis E, Luna AT, Luppi D, V. GMM, Maegele M, Maggiore D, Magnone S, Maier RV, Maier RV, Major P, Manangi M, manetti A, Mantoglu B, Marafante C, Mariani F, Marinis A, Mariot ES, Marseglia GR, Martãnez-Pãrez A, Martines G, Perez AM, Martino C, Mascagni P, Massalou D, Matãas-Garcãa B, Mazzarella G, Mazzarolo G, Melo RB, Mendoza-Moreno F, Meric S, Meyer J, Miceli L, Michalopoulos NV, Milana F, Mingoli A, Mishra TS, Mohamed M, Mohamed MIEA, Mohamedahmed AY, Mohammed MJS, Mohan R, Moore EE, Morales-Garcia D, Muhrbeck M, Mulita F, Mustafa SMS, Muttillo EM, Naimzada MD, Navsaria PH, Negoi I, Nespoli L, Nguyen C, Nidaw MK, Nigri G, Nikolopoulos I, O’Connor DB, Ogundipe HD, Oliveri C, Olmi S, Ong ECW, Orecchia L, Osipov AV, Othman MF, Pace M, Pacilli M, Pagani L, Palomba G, Pantalone D, Panyko A, Paolillo C, Papa MV, Papaconstantinou D, Papadoliopoulou M, Papadopoulos A, Papis D, Pararas N, Parreira JG, Parry NG, Pata F, Patel T, Paterson-Brown S, Pavone G, Pecchini F, Pellino G, Pelloni M, Peloso A, del Pozo EP, Pereira RG, Pereira BM, perez AL, Perra T, Perrone G, Pesce A, Petagna L, Petracca G, Phupong V, Picardi B, Picciariello A, Piccoli M, Piccolo D, Picetti E, Pikoulis Pikoulis E, Pintar T, Pirozzolo G, Piscioneri F, Podda M, Porcu A, Privitera F, Punzo C, Quaresima S, Quiodettis MA, Qvist N, Rahim R, de Almeida FR, Ramely RB, Rasa HK, Reichert M, Reinisch-Liese A, Renne A, Riccetti C, Rodriguez-Luna MR, Roizblatt D, Romanzi A, Romeo L, Roscio FPM, Rosnelifaizur RB, Rossi S, Rubiano AM, Ruiz-Úcar E, Sakakushev BE, Salamea JC, Sall I, Samarakoon LB, Sammartano F, Arteaga AS, Sanchez-Cordero S, Santoanastaso DPM, Sasia D, Sato N, Savchuk A, Sawyer RG, Scaioli G, Schizas D, Sebastiani S, Seeliger B, Lohse HAS, Seretis C, Sermonesi G, Serradilla-Martin M, Shelat VG, Shlyapnikov S, Sidiropoulos T, Simoes RL, Siragusa L, Siribumrungwong B, Slavchev M, Solaini L, soldini G, Sopuev A, Soreide K, Sovatzidis A, Stahel PF, Strickland M, Sultan MAH, Sydorchuk R, Sydorchuk L, Syed SMAM, Syed AM, Tallon-Aguilar L, Tamburini AM, Tamini N, Tan ECTH, Tan JH, Tarasconi A, Tartaglia N, Tartaglia G, Tartaglia D, Taylor JV, Tebala GD, Gonsaga RAT, Teuben M, Theodorou A, Tolonen M, Tomasicchio G, Toro A, Torre B, Triantafyllou T, Trigiante Trigiante G, Tripepi M, Trostchansky J, Tsekouras K, Turrado-Rodriguez V, Tutino R, Uccelli M, Uchikov PA, Ugarte-Sierra B, Ukkonen MT, Vailas M, Vassiliu PG, Vazquez AG, Vazquez RG, Verde JE, Verde JM, Veroux M, Viganò J, Vilallonga R, Visconti D, Vittori A, Waledziak M, Wannatoop T, Widmer LW, Wilson MSJ, Wong TH, Xenaki S, Yu B, Yule S, Zachariah SK, Zacharis G, Zaghi C, Zakaria AD, Zambrano DA, Zampitis N, Zampogna B, Zanghã S, Zapsalis K, Zattoni F, Zese M, Farre SP, Atanasov BT, Pegoraro V, Zantedeschi M, Reitano E, Pizzocaro E. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J Emerg Surg 2023; 18:14. [PMID: 36803568 PMCID: PMC9936681 DOI: 10.1186/s13017-022-00464-6] [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: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy.
| | - Francesca Dal Mas
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, PV Italy ,grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Walter Biffl
- grid.415402.60000 0004 0449 3295Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Giovanni Butturini
- grid.513352.3Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Stefano Campostrini
- grid.7240.10000 0004 1763 0578Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Stefano Denicolai
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Jacopo Martellucci
- grid.24704.350000 0004 1759 9494Department of Surgery, Careggi University Hospital, Florence, Italy
| | - Maurizio Massaro
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Pietro Previtali
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | - Alessandro Venturi
- grid.8982.b0000 0004 1762 5736Department of Political and Social Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sarah Woltz
- grid.416219.90000 0004 0568 6419Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Haytham M. Kaafarani
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - Tyler J. Loftus
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, Gainesville, FL USA
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Gossot D, Boddaert G, Mariolo AV, Seguin-Givelet A. Sublobar resection for early-stage lung cancer: the issue of nodal upstaging. Eur J Cardiothorac Surg 2022; 62:6758246. [PMID: 36218413 DOI: 10.1093/ejcts/ezac481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dominique Gossot
- Thoracic Surgery Department, Curie-Montsouris Thoracic Institute, Paris, France
| | - Guillaume Boddaert
- Thoracic Surgery Department, Curie-Montsouris Thoracic Institute, Paris, France
| | | | - Agathe Seguin-Givelet
- Thoracic Surgery Department, Curie-Montsouris Thoracic Institute, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
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Grigoroiu M, Rheinwald M, Ryckembusch L, Kemper J, Brian E, Boddaert G, Seguin-Givelet A, Mariolo AV. Full subcostal subxiphoid robotic-assisted radical thymectomy: preclinical cadaveric study for optimizing patient positioning, table settings, and port configuration. Updates Surg 2022; 74:1733-1738. [PMID: 35211841 DOI: 10.1007/s13304-022-01253-1] [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: 08/05/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Robotic subxiphoid transthoracic thymectomy showed several surgical advantages. Nevertheless, the intercostal insertion of trocars may lead to nerve injury with enhanced post-operative pain. Moreover, the dissection of peri-diaphragmatic mediastinal fat may result challenging, in particular on left side, where the presence of the heart precludes the optimal visualization. We describe a preclinical cadaveric study of a novel full subcostal robotic-assisted technique to overcome these limitations. A total subcostal robotic-assisted radical thymectomy was evaluated on a cadaver model using the da Vinci Xi system. The exploratory procedure was divided in two steps: (a) dissection of the thymus gland, except the left mediastinal epi-diaphragmatic fat pad; (b) dissection of the left diaphragmatic mediastinal fat pad avoiding heart compression while perfectly visualizing the left phrenic nerve. Five different setups were explored based on camera and trocars insertions, patient's positioning and table's settings. Both the tasks were accomplished using the novel technique. The subxiphoid insertion of the camera and the position of two robotic arms about 8 cm distally on the subcostal made the most part of mediastinal dissection straightforward. Left peri-diaphragmatic fat pad can be better visualized and dissected positioning the camera in the left subcostal port shifting the instruments on the right side. This may permit a better control of the left phrenic nerve reducing heart compression. Full subcostal robotic-assisted thymectomy resulted feasible in cadaveric model. Clinical trial should be performed to confirm the translational use of this novel technique and the speculated advantages in living model.
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Affiliation(s)
- Madalina Grigoroiu
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Markus Rheinwald
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Louis Ryckembusch
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Justin Kemper
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Emmanuel Brian
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Guillaume Boddaert
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Alessio Vincenzo Mariolo
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France.
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Sabate-Ferris A, Pfister G, Boddaert G, Daban JL, de Rudnicki S, Caubere A, Demoures T, Travers S, Rongieras F, Mathieu L. Prolonged tactical tourniquet application for extremity combat injuries during war against terrorism in the Sahelian strip. Eur J Trauma Emerg Surg 2021; 48:3847-3854. [PMID: 34775509 DOI: 10.1007/s00068-021-01828-4] [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: 08/31/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study reports on complications following extended tourniquet application in patients with combat extremity injuries treated by the French Military Health Service in the Sahelian strip. METHODS A retrospective review was performed in a French forward medical treatment facility deployed in Gao, Mali, between 2015 and 2020. All patients treated for an extremity injury with the application of at least one tourniquet for a minimum of 3 h were included. Prehospital data were injury pattern, associated shock, tourniquet location, and duration. Subsequent complications and surgical procedures performed were analyzed. RESULTS Eleven patients with a mean age of 27.4 years (range 21-35 years) were included. They represented 39% of all patients in whom a tourniquet was applied. They had gunshot wounds (n = 7) or multiple blast injuries (n = 4) and totaled 14 extremity injuries requiring tourniquet application. The median ISS was 13 (interquartile range: 13). Tourniquets were mostly applied proximally on the limb for a mean duration of 268 min (range 180-360 min). Rhabdomyolysis was present in all cases. The damage control surgeries included debridement, external fixation, vascular repair, and primary amputation. Ten injuries were complicated by compartment syndrome requiring leg or thigh fasciotomy in the field or after repatriation. Two severely injured patients died of their wounds, but the others had a favorable outcome even though secondary amputation was sometimes required. CONCLUSIONS Extended and proximal tourniquet applications led to significant morbidity related to compartment syndrome and rhabdomyolysis. Hemorrhagic shock, mass casualty incident, and tactical constraints often precluded revising the temporary tourniquet applied under fire.
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Affiliation(s)
- Alexandre Sabate-Ferris
- Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Georges Pfister
- Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Hospital, Clamart, France.,French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | - Jean-Louis Daban
- Department of Anesthesiology and Intensive Care, Percy Military Hospital, Clamart, France
| | - Stéphane de Rudnicki
- Department of Anesthesiology and Intensive Care, Percy Military Hospital, Clamart, France
| | - Alexandre Caubere
- Department of Orthopedic and Trauma Surgery, Saint-Anne Military Hospital, Toulon, France
| | - Thomas Demoures
- Department of Orthopedic and Trauma Surgery, Bégin Military Hospital, Saint-Mandé, France
| | - Stéphane Travers
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.,Medical Department, Fire Brigade of Paris, Paris, France
| | - Fréderic Rongieras
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.,Department of Orthopedic and Trauma Surgery, Edouard Herriot Hospital, Lyon, France
| | - Laurent Mathieu
- Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, Clamart, France. .,French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
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7
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Gossot D, Mariolo AV, Lefevre M, Boddaert G, Brian E, Grigoroiu M, Girard N, Seguin-Givelet A. Strategies of Lymph Node Dissection During Sublobar Resection for Early-Stage Lung Cancer. Front Surg 2021; 8:725005. [PMID: 34631783 PMCID: PMC8495255 DOI: 10.3389/fsurg.2021.725005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/23/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Alessio Vincenzo Mariolo
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Marine Lefevre
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - Guillaume Boddaert
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Madalina Grigoroiu
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Girard
- Department of Oncology, Curie-Montsouris Thorax Institute-Institut Curie, Paris, France.,Faculty of Medicine Simone Veil, Paris Saclay University, UVSQ, Versailles, France
| | - Agathe Seguin-Givelet
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France.,Faculty of Medicine SMBH, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
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8
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Mariolo AV, Vieira T, Stern JB, Perrot L, Caliandro R, Escande R, Brian E, Grigoroiu M, Boddaert G, Gossot D, Seguin-Givelet A. Electromagnetic navigation bronchoscopy localization of lung nodules for thoracoscopic resection. J Thorac Dis 2021; 13:4371-4377. [PMID: 34422363 PMCID: PMC8339756 DOI: 10.21037/jtd-21-223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022]
Abstract
Background Thoracoscopic localization of small peripheral pulmonary nodules is a concern. Failure can lead to larger parenchymal resection or conversion to thoracotomy. This study evaluates our experience in preoperative electromagnetic navigation bronchoscopy-guided localization of small peripheral lung lesions. Methods From January 2017 to March 2020 clinical, radiographic, surgical, and pathological data of patients who underwent electromagnetic navigation bronchoscopy (ENB)-guided methylene blue pleural marking of highly suspected pulmonary lesions before a full thoracoscopic resection were evaluated. Localization was performed for solid or mixed subpleural nodules measuring <10 mm, solid nodules measuring <20 mm located at more than 1 cm from the pleura and any pure ground glass opacity. Successful localization was defined as successful identification and thoracoscopic resection of target lesions. Results Forty-eight patients were included: 30 solid nodules (63%), 12 pure GGO (25%) and 6 mixed (13%). The median largest diameter at CT-scan was 11 mm (IQR, 9-14 mm) while the median distance from the pleural surface was 12 mm (IQR, 6-16 mm). The median ENB length was 25 min (19-33 min). Localization procedure was successful in 45 cases (94%). No procedural-related complications were reported. Conclusions ENB is a safe and accurate preoperative procedure to localize small lung peripheral lesions. The high successful rate, the absence of related complications, the possibility of performing the procedure in the same operating room with a single general anesthesia, make ENB-guided dye marking an advantageous tool for thoracoscopic pulmonary resection.
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Affiliation(s)
- Alessio Vincenzo Mariolo
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Thibault Vieira
- Pulmonology Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris, Paris, France
| | - Jean-Baptiste Stern
- Pulmonology Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris, Paris, France
| | - Loïc Perrot
- Pulmonology Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris, Paris, France
| | - Raffaele Caliandro
- Pulmonology Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris, Paris, France
| | - Remi Escande
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Emmanuel Brian
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Madalina Grigoroiu
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Guillaume Boddaert
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Dominique Gossot
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Surgery Department, Institut du Thorax Curie-Montsouris-Institut Mutualiste Montsouris (IMM), Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
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9
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Gossot D, Mariolo AV, Grigoroiu M, Bardet J, Boddaert G, Brian E, Seguin-Givelet A. Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures. J Thorac Dis 2021; 13:4378-4387. [PMID: 34422364 PMCID: PMC8339731 DOI: 10.21037/jtd-20-3521] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/09/2021] [Indexed: 12/01/2022]
Abstract
Background Thoracoscopic complex basilar segmentectomies are technically demanding and challenging. We review our experience to check whether this complexity can lead to specific surgical issues or increased post-operative morbidity. Methods Complex basilar segmentectomies were defined as the anatomical resection of at least one segment composing the basilar pyramid, excluding S6. Data of patients who had an intention-to-treat thoracoscopic complex basilar segmentectomy were retrospectively collected from 2007 to 2019: indications, preoperative assessment, clinical features, operative technical aspects and early post-operative outcome. Results Sixty-three patients, 26 men (41%) and 37 women (59%) with a median age of 66 years and a median body mass index (BMI) of 26 kg/m2 were included. Interventions performed were mostly S9+10 (n=32) and S8 (n=12) segmentectomies. Forty-five planned operations (71%) were completed. Extension to a larger resection was necessary in 17 patients (27%) and 4 patients underwent conversion to open surgery (6%). Median operative time was 168 minutes with a median intraoperative bleeding of 30 mL. Complications occurred in 11 patients (17%). There was no mortality. Median length of pleural drainage was 2 days (range, 1–2 days) and median hospital stay 4 days. Conclusions The extension rate of complex basilar segmentectomy is higher than that of other sublobar resections but their post-operative morbidity is identical.
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Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Alessio Vincenzo Mariolo
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Madalina Grigoroiu
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Jérémy Bardet
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Guillaume Boddaert
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Emmanuel Brian
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
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10
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Caruhel JB, Sigaux N, Crambert A, Donat N, Boddaert G, Haen P, Hoffmann C. Military gas mask to protect surgeons when performing tracheotomies on patients with COVID-19. BMJ Mil Health 2021; 167:214. [PMID: 32753542 PMCID: PMC7409952 DOI: 10.1136/bmjmilitary-2020-001547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Jean-Baptiste Caruhel
- Maxillo-facial, Head and Neck Surgery Department, Hopital d'Instruction des Armees Percy, Clamart, France
| | - N Sigaux
- Maxillo-Facial Surgery Department, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - A Crambert
- Maxillo-facial, Head and Neck Surgery Department, Hopital d'Instruction des Armees Percy, Clamart, France
| | - N Donat
- Intensive Care Unit and Burn Center, Hopital d'Instruction des Armees Percy, Clamart, Île-de-France, France
| | - G Boddaert
- Department of Thoracic and Vascular Surgery, Hopital d'Instruction des Armees Percy, Clamart, Île-de-France, France
| | - P Haen
- Maxillo-Facial Surgery Department, Hopital d'Instruction des Armees Laveran, Marseille, Provence-Alpes-Côte d'Azur, France
| | - C Hoffmann
- Intensive Care Unit and Burn Center, Hopital d'Instruction des Armees Percy, Clamart, Île-de-France, France
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11
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Boutonnet M, Benbrika W, Facione J, Travers S, Boddaert G, Colas MD, Hornez E, Mathieu L, de Régloix S, Daban JL, Leclerc T, Pasquier P, Ausset S. Traum'cast: an online, open-access educational video podcast series for teaching military trauma care to all healthcare providers. BMJ Simul Technol Enhanc Learn 2021; 7:438-440. [DOI: 10.1136/bmjstel-2020-000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022]
Abstract
The aim of this paper was to describe the development of ‘Traum’cast’, an ambitious project to create a high-quality, open-access, 12-week video podcast programme providing evidence-based continuing medical education for civilian and military healthcare practitioners dedicated to the management of trauma caused by weapons of war. The management of such patients became a particular public health issue in France following the 2015 terrorist attacks in Paris, which highlighted the need for all healthcare professionals to have appropriate knowledge and training in such situations. In 2016, the French Health General Direction asked the French Military Medical Service (FMMS) to create a task force and to use its unique and considerable experience to produce high-quality educational material on key themes including war injuries, combat casualty care, triage, damage control surgery, transfusion strategies, psychological injury and rehabilitation. The material was produced by FMMS and first broadcast in French and for free, on the official FMMS YouTube channel in September 2020. Traum’cast provides evidence-based continuing medical education for civilian and military healthcare practitioners. Traum’cast is an educational innovation that meets a public health requirement.
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12
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Thabouillot O, Boddaert G, Travers S, Dubecq C, Derkenne C, Kedzierewicz R, Bertho K, Prunet B. Effectiveness of Short Training in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) by Emergency Physicians: The Applied Course for Internal Aortic Clamping on Field Mission. J Spec Oper Med 2021; 21:36-40. [PMID: 34529802 DOI: 10.55460/nyaw-f69l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique that uses internal clamping of the aorta to control abdominal, pelvic, or junctional bleeding. We created a course to train military physicians in both civilian prehospital use and battlefield use. To determine the effectiveness of this training, we conducted REBOA training for French military emergency physicians. METHODS We trained 15 military physicians, organizing the training as follows: a half-day of theoretical training, a half-day of training on mannequins, a half-day on human corpses, and a half-day on a living pig. The primary endpoint was the success rate after training. We defined success as the balloon being inflated in zone 1 of a PryTime mannequin. The secondary endpoints were the progression of each trainee during the training, the difference between the median completion duration before and after training, the median post-training duration, and the median duration for the placement of the sheath introducer before and after training. RESULTS Fourteen of the physicians (93%) correctly placed the balloon in the mannequin at the end of the training period. During the training, the success rate increased from 73% to 93% (p = .33). The median time for REBOA after training was only 222 seconds (interquartile range [IQR] 194-278), significantly faster than before training (330 seconds, IQR 260-360.5; p = .0033). We also found significantly faster sheath introducer placement (148 seconds, IQR 126-203 versus 145 seconds, IQR 115.5 - 192.5; p = .426). CONCLUSION The training can be performed successfully and paves the way for the use of REBOA by emergency physicians in austere conditions.
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13
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Boddaert G, Cornut C, Casalis S. Integration of newly learned L2 words into the mental lexicon is modulated by vocabulary learning method. Acta Psychol (Amst) 2021; 212:103220. [PMID: 33246309 DOI: 10.1016/j.actpsy.2020.103220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/05/2020] [Revised: 07/22/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of the study was to investigate both L2 word integration and the effect of learning method on it. For this purpose, an L2 word-learning paradigm was designed with two learning methods: L2 words were paired with videos in the first one and their translation-equivalent L1 words in the second. To test L2 word integration, a lexical decision task associated with form priming was administered before and after the learning phase. The L2 words to be learned were used as primes. Forty-eight participants participated in the study. Before learning, a facilitation effect was obtained with pseudowords (not already learned L2 words) as primes and L1 words as targets. After learning, L2 words no longer facilitated L1 word recognition when learned with the video method, while they still had this effect when learned with the L1 words - L2 words method. In accordance with the prime lexicality effect (PLE), this absence of a facilitation effect indicates that L1 words and L2 words are involved in a lexical competition process common to the two languages. This result highlights swift lexicalisation and demonstrates the effect of learning method in lexicalisation.
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Affiliation(s)
- G Boddaert
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; CNRS, UMR 9193, F-59000 Lille, France.
| | - C Cornut
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; CNRS, UMR 9193, F-59000 Lille, France
| | - S Casalis
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; CNRS, UMR 9193, F-59000 Lille, France
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14
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Gossot D, Mariolo AV, Brian E, Boddaert G, Seguin-Givelet A. Full thoracoscopic segmentectomies for lung cancer: rational of a multiportal fissure-based approach. J Vis Surg 2021. [DOI: 10.21037/jovs-21-30] [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: 11/06/2022]
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15
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de Carbonnières A, Moritz C, Destan C, Daban JL, Boddaert G, Bonnet S, Hornez E. A decade in the battlefield (2004-2014): A French military perspective on the high mortality associated with non-exclusively orthopedic or brain combat injuries. Injury 2020; 51:2046-2050. [PMID: 32451146 DOI: 10.1016/j.injury.2020.04.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND During the last few decades, French armed forces have regularly deployed in asymmetric conflicts. Surgical support for casualties of these conflicts occurs in NATO role 2 and 3 medical treatment facilities (MTF); definitive surgical care occurs in France following a strategic medical evacuation. The aim of this study was to describe the combat injury profile of these soldiers who presented with either non-exclusively orthopedic and/or brain injuries. METHODS This descriptive study is a retrospective analysis of the surgical management of French casualties performed in role 2 or 3 MTF in Afghanistan, Mali, Niger, Djibouti and the Central African Republic between January 2004 and December 2014. RESULTS One hundred patients were included. Forty had fragment wounds. The most severe lesions were of the head, neck or thorax. The average injury severity score (ISS) was 34.9 (IC 95% 29.8-40). 17 damage control procedures were performed. Thirty patients died with a mean ISS of 61 (IC 95% 56-67); 5 deaths were considered as preventable. The most frequent surgical procedures in the MTF were digestive (n=31) and thoracic surgery (n=19). Thirty patients needed second-look surgery in France; eleven had severe complications. No patient died following medical evacuation to France. CONCLUSIONS Results from this study indicated that the mortality following non-exclusively brain or orthopedic injuries remains high in modern asymmetric conflicts. Level of Evidence IV.
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Affiliation(s)
- Anne de Carbonnières
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Céline Moritz
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Clément Destan
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Jean-Louis Daban
- Critical care department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Guillaume Boddaert
- Thoracic surgery, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France; French Military Health Service, Val de Grâce Military Academy, Paris, Paris, France
| | - Stéphane Bonnet
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France.; French Military Health Service, Val de Grâce Military Academy, Paris, Paris, France
| | - Emmanuel Hornez
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France.; French Military Health Service, Val de Grâce Military Academy, Paris, Paris, France..
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16
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Mathieu L, Ghabi A, Amar S, Murison JC, Boddaert G, Levadoux M. The state of microsurgical practice in French forward surgical facilities from 2003 to 2015. Hand Surg Rehabil 2019; 38:358-363. [PMID: 31550553 DOI: 10.1016/j.hansur.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/30/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022]
Abstract
Microsurgery is an unusual procedure in the theatres of military operations. We sought to analyze the state of microsurgical practices in the French medical treatment facilities (MTFs) deployed around the world in the 21st century. A retrospective study was conducted among all patients who were operated on in French forward surgical facilities between 2003 and 2015. Those who underwent microsurgical procedures for nerve injury, vascular injury, or extremity reconstruction were included. Only early vascular results were assessed. Among the 2589 patients operated on for an extremity injury during the study period, 56 (2.1%) were included, with the group composed of 29 patients with isolated nerve injuries, 28 patients with nerve and arterial injuries, and two patients with isolated arterial injuries, mostly at the hand level. Nerve procedures predominantly consisted of direct suturing, although autografting and nerve transfers were also performed. Thirteen microvascular repairs were carried out, including nine cases of proximal or digital revascularization; revascularization was successful in six of the nine cases. These procedures were completed by orthopedic surgeons trained in microsurgery, mostly under loupes magnification. Routine nerve repair in the field seems to be specific to French MTFs. Salvage of amputated or devascularized fingers in the combat zone had never been reported before. Such emphasizes the need to train deployed orthopedic surgeons to perform microsurgical procedures and to equip all MTFs with basic microsurgical sets and magnification means.
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Affiliation(s)
- L Mathieu
- Department of orthopedic, traumatology and reconstructive surgery, Percy Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France; Department of surgery, French Military Medical Academy, École du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
| | - A Ghabi
- Department of orthopedic, traumatology and reconstructive surgery, Percy Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - S Amar
- Department of orthopedic, traumatology and reconstructive surgery, Percy Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - J-C Murison
- Department of orthopedic, traumatology and reconstructive surgery, Percy Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - G Boddaert
- Department of vascular and thoracic surgery, Percy Military Hospital, 1, rue du Lieutenant-Raoul-Batany, 92190 Clamart, France; Department of surgery, French Military Medical Academy, École du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
| | - M Levadoux
- Hand surgery unit, Saint-Roch private clinic, 99, avenue Saint-Roch, 83000 Toulon, France
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17
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Thabouillot O, Derkenne C, Boddaert G, Prunet B. Prehospital REBOA: Time to clearly define the relevant indications. Resuscitation 2019; 142:190. [DOI: 10.1016/j.resuscitation.2019.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
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Swiech A, Boddaert G, Daban JL, Falzone E, Ausset S, Boutonnet M. Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre. BMJ Mil Health 2019; 167:33-39. [PMID: 31175165 DOI: 10.1136/jramc-2019-001159] [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: 01/09/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Penetrating thoracic injuries (PTIs) is a medicosurgical challenge for civilian and military trauma teams. In civilian European practice, PTIs are most likely due to stab wounds and mostly require a simple chest tube drainage. On the battlefield, combat casualties suffer severe injuries, caused by high-lethality wounding agents.The aim of this study was to analyse and compare the demographics, injury patterns, surgical management and clinical outcomes of civilian and military patients with PTIs. METHODS All patients with PTIs admitted to a Level I Trauma Centre in France or to Role-2 facilities in war theatres between 1 January 2004 and 31 May 2016 were included. Combat casualties' data were analysed from Role-2 medical charts. The hospital manages military casualties evacuated from war theatres who had already received primary surgical care, but also civilian patients issued from the Paris area. During the study period, French soldiers were deployed in Afghanistan, in West Africa and in the Sahelo-Saharan band since 2013. RESULTS 52 civilian and 17 military patients were included. Main mechanisms of injury were stab wounds for civilian patients, and gunshot wounds and explosive fragments for military casualties. Military patients suffered more severe injuries and needed more thoracotomies. In total, 29 (33%) patients were unstable or in cardiac arrest on admission. Thoracic surgery was performed in 38 (55%) patients (25 thoracotomies and 13 thoracoscopies). Intrahospital mortality was 18.8%. CONCLUSION War PTIs are associated with extrathoracic injuries and higher mortality than PTIs in the French civilian area. In order to reduce the mortality of PTIs in combat, our study highlights the need to improve tactical en route care with transfusion capabilities and the deployment of forward surgical units closer to the combatants. In the civilian area, our results indicated that video-assisted thoracoscopic surgery is a reliable diagnostic and therapeutic technique for haemodynamically stable patients.
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Affiliation(s)
- Astree Swiech
- Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
| | - G Boddaert
- Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - J-L Daban
- Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
| | - E Falzone
- Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
| | - S Ausset
- Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
| | - M Boutonnet
- Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
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Malgras B, Aoun O, Pauleau G, Boddaert G, Hornez E, Dulou R, Delmas JM, Haen P, Laversanne S, Crambert A, Balandraud P. Deployment of the Surgical Life-saving Module (SLM) in 2017: Lessons learned in setting up and training operational surgical units. Injury 2019; 50:1133-1137. [PMID: 30851979 DOI: 10.1016/j.injury.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/13/2019] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The military operations carried out by the French armed forces, occasionally require the use of the Surgical Life-saving Module (SLM), to ensure the surgical support of its soldiers. Due to its extreme mobility and capacity of fast deployment, SLM is particularly useful in small-scale military operations, such as Special Forces missions. In 2017, the French SLM was for the first time used to ensure surgical support of allied forces, which were lacking forward surgical capabilities. MATERIALS AND METHODS the SLM is a mobile, heliborne, airborne, surgical structure with parachuting capability onto land or sea, therefore essentially focused on life-saving procedures, also known as "damage control" surgery. Due to the need for mobility and rapid implementation, the SLM is limited to a maximum of 5 interventions or, in terms of injuries, to 1 or 2 seriously injured patients. RESULTS Over a period of 2 months, 5 medical teams were successively deployed with the SLM. A total of 157 casualties were treated. The most common injuries were caused by shrapnel 561%), followed by firearms (36%), and blunt trauma (2.5%). Injuries included the limbs (56%), thorax (18%), abdomen (13%), head (11%), and neck (2%). The average ISS was 8.5 (1-25) with 26 patients presenting with an ISS greater than or equal to 15. The average NISS was 10.8 (1-75) with 34 casualties having an NISS equal to or greater than 15. The surgical procedures were broken down as follows: 126 dressings, 16 laparotomies, 7 thoracotomies, 12 isolated thoracic drains (without thoracotomy), 1 cervicotomy, 12 amputations, 7 limb splints, 2 limb fasciotomies, 2 external fixators and 1 femoral fracture traction. CONCLUSIONS The numerous SLM deployments in larger operations highlighted its ability to adapt both in terms of equipment and personnel. Continuous management of equipment logistics, robust personnel training, and appropriate organization of the evacuation procedures, were the key elements for optimizing combat casualty care. As a consequence, the SLM appears to be an operational surgical unit of choice during deployments.
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Affiliation(s)
- Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France.
| | - Olivier Aoun
- 5th Armed Forces Medical Center, Strasbourg, France
| | - Ghislain Pauleau
- Department of Gastrointestinal Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Guillaume Boddaert
- Department of Gastrointestinal, Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - Emmanuel Hornez
- Department of Gastrointestinal, Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - Renaud Dulou
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart, France
| | - Pierre Haen
- Departmet of Maxillofacial Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Sophie Laversanne
- Departmet of Maxillofacial Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Anna Crambert
- Department of Otorhinolaryngology, Percy Military Teaching Hospital, Clamart, France
| | - Paul Balandraud
- Department of Gastrointestinal Surgery, Saint-Anne Military Teaching Hospital, Toulon, France
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Thabouillot O, Bertho K, Rozenberg E, Roche NC, Boddaert G, Jost D, Tourtier JP. How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade. J ROY ARMY MED CORPS 2018; 164:267-270. [PMID: 29487207 DOI: 10.1136/jramc-2018-000915] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 01/15/2018] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014. Inclusion criteria included all patients over 18 years of age with bleeding of supposedly abdominal and/or pelvic and/or junctional origin, uncontrolled haemorrhagic shock or cardiac arrest with attempted resuscitation. RESULTS During this study period, a total of 1159 patients with trauma (3.2%) would have been eligible to undergo REBOA. Death on scene rate was 83.8% (n=31) and six patients had a beating heart when they arrived at the hospital. Ten out of the 37 patients had spontaneous circulatory activity. Among them, four people died on the scene or during transport. Thirty-six out of 37 patients were intubated, one benefited from the use of a haemostatic dressing and one benefited from a tourniquet. CONCLUSIONS REBOA can be seen as an effective non-surgical solution to ensure complete haemostasis during the prehospital setting. When comparing the high mortality rate following haemorrhage with the REBOA's rare side effects, the risk-benefit balance is positive. Given that 3% of all patients with trauma based on this study would have been eligible for REBOA, we believe that this intervention should be available in the prehospital setting. The results of this study will be used: educational models for REBOA balloon placement using training manikins, with an ultimate aim to undertake a prospective feasibility study in the prehospital setting.
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Affiliation(s)
| | - K Bertho
- Paris Fire Brigade, Paris, France
| | | | - N-C Roche
- Department of Cardiology, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - G Boddaert
- Department of Thoracic and Vascular surgery, HIA Percy, Clamart, France
| | - D Jost
- Paris Fire Brigade, Paris, France
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Pégorié A, Amabile J, Dondey M, Boddaert G, De Carbonnières A, Bauss A, Pierret C, Entine F, Michel X, Erauso T, Gagna G. Chirurgie endovasculaire : évaluation de l’exposition radiologique et proposition d’axes d’amélioration. ARCH MAL PROF ENVIRO 2018. [DOI: 10.1016/j.admp.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hornez E, Béranger F, Monchal T, Baudouin Y, Boddaert G, De Lesquen H, Bourgouin S, Goudard Y, Malgras B, Pauleau G, Reslinger V, Mocellin N, Natale C, Meyrat L, Avaro JP, Balandraud P, Gaujoux S, Bonnet S. Management specificities for abdominal, pelvic and vascular penetrating trauma. J Visc Surg 2017; 154:S1878-7886(17)30126-1. [PMID: 29239852 DOI: 10.1016/j.jviscsurg.2017.10.009] [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] [Indexed: 11/30/2022]
Abstract
Management of patients with penetrating trauma of the abdomen, pelvis and their surrounding compartments as well as vascular injuries depends on the patient's hemodynamic status. Multiple associated lesions are the rule. Their severity is directly correlated with initial bleeding, the risk of secondary sepsis, and lastly to sequelae. In patients who are hemodynamically unstable, the goal of management is to rapidly obtain hemostasis. This mandates initial laparotomy for abdominal wounds, extra-peritoneal packing (EPP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) in the emergency room for pelvic wounds, insertion of temporary vascular shunts (TVS) for proximal limb injuries, ligation for distal vascular injuries, and control of exteriorized extremity bleeding with a tourniquet, compressive or hemostatic dressings for bleeding at the junction or borderline between two compartments, as appropriate. Once hemodynamic stability is achieved, preoperative imaging allow more precise diagnosis, particularly for retroperitoneal or thoraco-abdominal injuries that are difficult to explore surgically. The surgical incisions need to be large, in principle, and enlarged as needed, allowing application of damage control principles.
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Affiliation(s)
- E Hornez
- Service de chirurgie viscérale et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - F Béranger
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - T Monchal
- Service de chirurgie viscérale, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - Y Baudouin
- Service de chirurgie viscérale et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - G Boddaert
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - H De Lesquen
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - S Bourgouin
- Service de chirurgie viscérale, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - Y Goudard
- Service de chirurgie digestive, endocrinienne et métabolique, HIA Laveran, 13013 Marseille, France
| | - B Malgras
- Service de chirurgie viscérale, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - G Pauleau
- Service de chirurgie digestive, endocrinienne et métabolique, HIA Laveran, 13013 Marseille, France
| | - V Reslinger
- Service de chirurgie viscérale et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - N Mocellin
- Service de chirurgie viscérale et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - C Natale
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - L Meyrat
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-P Avaro
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France
| | - P Balandraud
- Service de chirurgie viscérale, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France
| | - S Gaujoux
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Bonnet
- Service de chirurgie viscérale et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France.
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Affiliation(s)
- H De Lesquen
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 9, France.
| | - F Beranger
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - C Natale
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - G Boddaert
- Service de chirurgie thoracique, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - J-P Avaro
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 9, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France
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Malgras B, Prunet B, Lesaffre X, Boddaert G, Travers S, Cungi PJ, Hornez E, Barbier O, Lefort H, Beaume S, Bignand M, Cotte J, Esnault P, Daban JL, Bordes J, Meaudre E, Tourtier JP, Gaujoux S, Bonnet S. Damage control: Concept and implementation. J Visc Surg 2017; 154 Suppl 1:S19-S29. [PMID: 29055663 DOI: 10.1016/j.jviscsurg.2017.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The concept of damage control (DC) is based on a sequential therapeutic strategy that favors physiological restoration over anatomical repair in patients presenting acutely with hemorrhagic trauma. Initially described as damage control surgery (DCS) for war-wounded patients with abdominal penetrating hemorrhagic trauma, this concept is articulated in three steps: surgical control of lesions (hemostasis, sealing of intestinal spillage), physiological restoration, then surgery for definitive repair. This concept was quickly adapted for intensive care management under the name damage control resuscitation (DCR), which refers to the modalities of hospital resuscitation carried out in patients suffering from traumatic hemorrhagic shock within the context of DCS. It is based mainly on specific hemodynamic resuscitation targets associated with early and aggressive hemostasis aimed at prevention or correction of the lethal triad of hypothermia, acidosis and coagulation disorders. Concomitant integration of resuscitation and surgery from the moment of admission has led to the concept of an integrated DCR-DCS approach, which enables initiation of hemostatic resuscitation upon arrival of the injured person, improving the patient's physiological status during surgery without delaying surgery. This concept of DC is constantly evolving; it stresses management of the injured person as early as possible, in order to initiate hemorrhage control and hemostatic resuscitation as soon as possible, evolving into a concept of remote DCR (RDCR), and also extended to diagnostic and therapeutic radiological management under the name of radiological DC (DCRad). DCS is applied only to the most seriously traumatized patients, or in situations of massive influx of injured persons, as its universal application could lead to a significant and unnecessary excess-morbidity to injured patients who could and should undergo definitive treatment from the outset. DCS, when correctly applied, significantly improves the survival rate of war-wounded.
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Affiliation(s)
- B Malgras
- Service de chirurgie viscérale, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France
| | - B Prunet
- Fédération anesthésie-réanimation-brûlés, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - X Lesaffre
- Brigade des sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - G Boddaert
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - S Travers
- Brigade des sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - P-J Cungi
- Fédération anesthésie-réanimation-brûlés, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - E Hornez
- Service de chirurgie viscérale et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - O Barbier
- Service de chirurgie orthopédique et traumatologique, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - H Lefort
- Brigade des sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - S Beaume
- Fédération anesthésie-réanimation-brûlés, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - M Bignand
- Brigade des sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - J Cotte
- Fédération anesthésie-réanimation-brûlés, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - P Esnault
- Fédération anesthésie-réanimation-brûlés, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-L Daban
- Service d'anesthésie-réanimation, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - J Bordes
- Fédération anesthésie-réanimation-brûlés, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - E Meaudre
- Fédération anesthésie-réanimation-brûlés, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France
| | - J-P Tourtier
- Brigade des sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France
| | - S Gaujoux
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Bonnet
- Service de chirurgie viscérale et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France.
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Abstract
Resuscitation thoracotomy is a rarely performed procedure whose use, in France, remains marginal. It has five specific goals that correspond point-by-point to the causes of traumatic cardiac arrest: decompression of pericardial tamponade, control of cardiac hemorrhage, performance of internal cardiac massage, cross-clamping of the descending thoracic aorta, and control of lung injuries and other intra-thoracic hemorrhage. This approach is part of an overall Damage Control strategy, with a targeted operating time of less than 60minutes. It is indicated for patients with cardiac arrest after penetrating thoracic trauma if the duration of cardio-pulmonary ressuscitation (CPR) is <15minutes, or <10minutes in case of closed trauma, and for patients with refractory shock with systolic blood pressure <65mm Hg. The overall survival rate is 12% with a 12% incidence of neurological sequelae. Survival in case of penetrating trauma is 10%, but as high as 20% in case of stab wounds, and only 6% in case of closed trauma. As long as the above-mentioned indications are observed, resuscitation thoracotomy is fully justified in the event of an afflux of injured victims of terrorist attacks.
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Affiliation(s)
- G Boddaert
- Thoracic and vascular surgery department, Percy Military teaching hospital, 101, avenue Henri Barbusse, 92104 Clamart, France.
| | - E Hornez
- General and digestive surgery department, Percy Military teaching hospital, 101, avenue Henri Barbusse, 92104 Clamart, France
| | - H De Lesquen
- Thoracic and vascular surgery department, Sainte-Anne Military teaching hospital, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - A Avramenko
- Thoracic and vascular surgery department, Percy Military teaching hospital, 101, avenue Henri Barbusse, 92104 Clamart, France
| | - B Grand
- Thoracic and vascular surgery department, Percy Military teaching hospital, 101, avenue Henri Barbusse, 92104 Clamart, France
| | - T MacBride
- Thoracic and vascular surgery department, Percy Military teaching hospital, 101, avenue Henri Barbusse, 92104 Clamart, France
| | - J-P Avaro
- Thoracic and vascular surgery department, Sainte-Anne Military teaching hospital, 2, boulevard Sainte-Anne, 83800 Toulon, France
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Abstract
INTRODUCTION Injuries to the innominate artery are rare, but potentially fatal. Early diagnosis and treatment may avoid life-threatening complications. Endovascular surgery often has lower morbidity and mortality rates than conventional surgery. CLINICAL CASE We reported the case of a 28-year-old Yemenite soldier who presented with a shrapnel-related chest puncture wound following a shell explosion in Djibouti causing a 5 mm pseudoaneurysm of the innominate artery without associated complications. After medical repatriation to France, the pseudoaneurysm was treated by endovascular exclusion using a covered stent. DISCUSSION Endovascular treatment of supra-aortic trunk lesions is an alternative to surgery with fewer postoperative complications, but long-term follow-up is lacking.
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Affiliation(s)
| | - Olivier Aoun
- Colmar Armed Forces Medical Center, Colmar, France
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Boddaert G, Mordant P, Le Pimpec-Barthes F, Martinod E, Aguir S, Leprince P, Raux M, Couëtil JP, Fiore A, Lescot T, Malgras B, Pons F, Castier Y. Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015. Eur J Cardiothorac Surg 2017; 51:1195-1202. [DOI: 10.1093/ejcts/ezx036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/17/2017] [Indexed: 11/14/2022] Open
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Bouzat P, Raux M, David JS, Tazarourte K, Galinski M, Desmettre T, Garrigue D, Ducros L, Michelet P, Freysz M, Savary D, Rayeh-Pelardy F, Laplace C, Duponq R, Monnin Bares V, D'Journo XB, Boddaert G, Boutonnet M, Pierre S, Léone M, Honnart D, Biais M, Vardon F. Chest trauma: First 48hours management. Anaesth Crit Care Pain Med 2017; 36:135-145. [PMID: 28096063 DOI: 10.1016/j.accpm.2017.01.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions. Thus, whatever the severity, a fast-acting strategy must be organized. At this time, there are no guidelines available from scientific societies. These expert recommendations aim to establish guidelines for chest trauma management in both prehospital an in hospital settings, for the first 48hours. The "Société française d'anesthésie réanimation" and the "Société française de médecine d'urgence" worked together on the 7 following questions: (1) criteria defining severity and for appropriate hospital referral; (2) diagnosis strategy in both pre- and in-hospital settings; (3) indications and guidelines for ventilatory support; (4) management of analgesia; (5) indications and guidelines for chest tube placement; (6) surgical and endovascular repair indications in blunt chest trauma; (7) definition, medical and surgical specificity of penetrating chest trauma. For each question, prespecified "crucial" (and sometimes also "important") outcomes were identified by the panel of experts because it mattered for patients. We rated evidence across studies for these specific clinical outcomes. After a systematic Grade® approach, we defined 60 recommendations. Each recommendation has been evaluated by all the experts according to the DELPHI method.
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Affiliation(s)
- Pierre Bouzat
- Grenoble Alpes trauma centre, pôle anesthésie-réanimation, CHU de Grenoble, Inserm U1216, institut des neurosciences de Grenoble, université Grenoble Alpes, 38700 La Tronche, France
| | - Mathieu Raux
- SSPI - accueil des polytraumatisés, hôpital universitaire Pitié-Salpêtrière - Charles-Foix, 75013 Paris, France
| | - Jean Stéphane David
- Service d'anesthésie-réanimation, centre hospitalier Lyon Sud, faculté de médecine Lyon Est, université Lyon 1 Claude-Bernard, 69310 Pierre-Bénite, France
| | - Karim Tazarourte
- Service des urgences, pôle URMARS, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69003 Lyon, France
| | - Michel Galinski
- Pôle urgences adultes - Samu, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - Thibault Desmettre
- Urgences/Samu CHRU de Besançon, université de Bourgogne Franche Comté, UMR 6249 CNRS/UFC, 25030 Besançon, France
| | | | - Laurent Ducros
- Service de réanimation polyvalente, pôle anesthésiologie, réanimation, hôpital Sainte-Musse, 83000 Toulon, France
| | - Pierre Michelet
- Services des urgences adultes, hôpital de la Timone, UMR MD2 - Aix Marseille université, 13005 Marseille, France.
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de Lesquen H, Beranger F, Berbis J, Boddaert G, Poichotte A, Pons F, Avaro JP. Corrigendum to "Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009-2013)" [Injury 47 (2016) 1939-1944]. Injury 2016; 47:2841. [PMID: 27743599 DOI: 10.1016/j.injury.2016.09.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France.
| | - Fabien Beranger
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Julie Berbis
- Aix-Marseille University, EA 3279-Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - Antoine Poichotte
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France
| | - Francois Pons
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France
| | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France
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de Lesquen H, Beranger F, Berbis J, Boddaert G, Poichotte A, Pons F, Avaro JP. Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009-2013). Injury 2016; 47:1939-44. [PMID: 27418455 DOI: 10.1016/j.injury.2016.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war. METHODS From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included. RESULTS Eighty-nine casualties were included who were mainly civilian (61%) and men (94%) with a mean age of 27.9 years old. Surgeons dealt with polytraumas (78%), severe injuries (mean Injury Severity Score=39.2) and penetrating wounds (96%) due to explosion in 37%, gunshot in 53% and stabbing in 9%. Most of casualties were first observed or drained (n=56). In this non-operative group more than 40% of casualties needed further actions. In the operative group, Damage Control Thoracotomy (n=22) was performed to stop ongoing bleeding and air leakage and Emergency Department Thoracotomy (n=11) for agonal patient. Casualties suffered from hemothorax (60%), pneumothorax (39%), diaphragmatic (37%), lung (35%), heart or great vessels (20%) injuries. The main actions were diaphragmatic sutures (n=25), lung resections (wedge n=6, lobectomy n=4) and haemostasis (intercostal artery ligation n=3, heart injury repairs n=5, great vessels injury repairs n=5). Overall mortality was 11%. The rate of subsequent surgery was 34%. CONCLUSIONS The analysis of the OPEX(®) registry reflects the thoracic surgical challenges of general (visceral) surgeons serving in combat environment during the latest Afghanistan War.
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Affiliation(s)
- Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France.
| | - Fabien Beranger
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Julie Berbis
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France.
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France.
| | - Antoine Poichotte
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France.
| | - Francois Pons
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France.
| | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France.
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Bonnet S, Gonzalez F, Mathieu L, Boddaert G, Hornez E, Bertani A, Avaro JP, Durand X, Rongieras F, Balandraud P, Rigal S, Pons F. The French Advanced Course for Deployment Surgery (ACDS) calledCours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects. J ROY ARMY MED CORPS 2015; 162:343-347. [DOI: 10.1136/jramc-2015-000528] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/15/2015] [Indexed: 11/04/2022]
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Hornez E, Boddaert G, Ngabou UD, Aguir S, Baudoin Y, Mocellin N, Bonnet S. Temporary vascular shunt for damage control of extremity vascular injury: A toolbox for trauma surgeons. J Visc Surg 2015; 152:363-8. [PMID: 26456452 DOI: 10.1016/j.jviscsurg.2015.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In an emergency, a general surgeon may be faced with the need to treat arterial trauma of the extremities when specialized vascular surgery is not available in their hospital setting, either because an arterial lesion was not diagnosed during pre-admission triage, or because of iatrogenic arterial injury. The need for urgent control of hemorrhage and limb ischemia may contra-indicate immediate transfer to a hospital with a specialized vascular surgery service. For a non-specialized surgeon, hemostasis and revascularization rely largely on damage control techniques and the use of temporary vascular shunts (TVS). Insertion of a TVS is indicated for vascular injuries involving the proximal portion of extremity vessels, while hemorrhage from distal arterial injuries can be treated with simple arterial ligature. Proximal and distal control of the injured vessel must be obtained, followed by proximal and distal Fogarty catheter thrombectomy and lavage with heparinized saline. The diameter of the TVS should be closely approximated to that of the artery; use of an oversized TVS may result in intimal tears. Systematic performance of decompressive fasciotomy is recommended in order to prevent compartment syndrome. In the immediate postoperative period, the need for systematic use of anticoagulant or anti-aggregant medications has not been demonstrated. The patient should be transferred to a specialized center for vascular surgery as soon as possible. The interval before definitive revascularization depends on the overall condition of the patient. The long-term limb conservation results after placement of a TVS are identical to those obtained when initial revascularization is performed.
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Affiliation(s)
- E Hornez
- Hôpital d'Instruction des Armées Percy, Clamart, France.
| | - G Boddaert
- Hôpital d'Instruction des Armées Percy, Clamart, France
| | - U D Ngabou
- Hôpital d'Instruction des Armées Percy, Clamart, France
| | - S Aguir
- Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Y Baudoin
- Hôpital d'Instruction des Armées Percy, Clamart, France
| | - N Mocellin
- Hôpital d'Instruction des Armées Percy, Clamart, France
| | - S Bonnet
- Hôpital d'Instruction des Armées Percy, Clamart, France
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Bonnet S, Bertani A, Savoie PH, Mathieu L, Boddaert G, Gonzalez F, Poichotte A, Durand X, Rongiéras F, Balandraud P, Pons F, Rigal S. Humanitarian Surgical Care Provided by a French Forward Surgical Team: Ten Years of Providing Medical Support to the Population of the Ivory Coast. Mil Med 2015; 180:1075-82. [DOI: 10.7205/milmed-d-14-00688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hornez E, Boddaert G, Baudoin Y, Daban JL, Ollat D, Ramiara P, Bonnet S. Concomitant Vascular War Trauma Saturating a French Forward Surgical Team Deployed to Support the Victims of the Syrian War (2013). Interest of the Vascular Damage Control. Ann Vasc Surg 2015; 29:1656.e7-12. [PMID: 26362619 DOI: 10.1016/j.avsg.2015.04.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/10/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
Vascular injuries from war require an emergency treatment whose objective is to quickly obtain hemostasis and the restoration of arterial flow. In this context of heavy trauma and limited means, damage control surgery is recommended and is based on the use of temporary vascular shunts (TVSs). We report the management of the simultaneous arrival of 2 vascular injuries of war in a field hospital. Patient 1 presented a ballistic trauma of the elbow with a section of the humeral artery (Gustillo IIIC). A TVS was set up during the external fixation of the elbow. Final revascularization was carried out and aponevrotomies of the forearm were performed. Patient 2 had a riddled knee with an open fracture of the femur, an avulsion of the popliteal artery, and a hemorrhagic shock. A strategy of damage control surgery was carried out with placing an arterial and venous shunt. Aponevrotomies of the leg were carried out before casting. For the traumatisms of the arteries of the members, the use of shunts is reserved for the lesions of the proximal vessels. Many vascular shunts available have the same performances to restore the arterial flow and prevent secondary thrombosis. The time before the final revascularization depends on the clinical condition of the patient. The value of anticoagulation in these cases was not shown.
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Affiliation(s)
- Emmanuel Hornez
- Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France.
| | - Guillaume Boddaert
- Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Yoann Baudoin
- Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Jean Louis Daban
- Département d'anesthésie et réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Didier Ollat
- Service de chirurgie orthopédique, Hôpital d'Instruction des Armées Begin, Toulon, France
| | - Patrice Ramiara
- Département d'anesthésie et réanimation, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France
| | - Stéphane Bonnet
- Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France
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de l'Escalopier N, Boddaert G, Erauso T, Hornez E. Acute Abdominal Pain: Mind the Superior Mesenteric Artery Dissection. J Emerg Med 2015; 49:e155-7. [PMID: 26162761 DOI: 10.1016/j.jemermed.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/23/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Thomas Erauso
- Department of Medical Imaging, Percy Military Hospital, Clamart, France
| | - Emmanuel Hornez
- General and Gastrointestinal Surgery Department, Percy Military Hospital, Clamart, France
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Aguir S, Boddaert G, Weber G, Hornez E, Pons F. [Lung hernia provoked by a cough fit]. Rev Pneumol Clin 2015; 71:60-63. [PMID: 25687819 DOI: 10.1016/j.pneumo.2014.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/30/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
Lung hernias are rare and their pathogenesis is few described. They are defined as the protrusion of lung parenchyma through the chest wall: intercostal space, inter-costo-clavicular, supra-clavicular or diaphragmatic hiatus. Lung hernias are classically divided into congenital and acquired hernias. Those are usually post-traumatic or post-surgical but can be provoked by cough. Clinical diagnosis is often evident but is confirmed by chest radiograph and especially computed tomography. Major risks are lung incarceration and necrosis but also ventilatory distress due to paradoxical respiration, in case of large defect. Treatment is first and foremost surgical but debated and should consider the localization, the size, the length of evolution and the possible infectious context. We report the case of a right basi-thoracic lung hernia induced by a cough fit, in a patient with chronic bronchitis.
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Affiliation(s)
- S Aguir
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - G Boddaert
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - G Weber
- Service d'imagerie médicale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - E Hornez
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - F Pons
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
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Boddaert G, Guiraudet P, Grand B, Venissac N, Le Pimpec-Barthes F, Mouroux J, Riquet M. Solitary fibrous tumors of the pleura: a poorly defined malignancy profile. Ann Thorac Surg 2015; 99:1025-31. [PMID: 25620590 DOI: 10.1016/j.athoracsur.2014.10.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/08/2014] [Accepted: 10/14/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical characteristics and factors that influence the long-term outcomes of solitary fibrous tumors of the pleura. METHODS We conducted a retrospective study in 2 centers and reviewed 80 patients who underwent surgery between May 1984 and April 2011. RESULTS Of the 80 patients (29 male; median age, 60 years [33 to 85 years]), 47 were symptomatic (59%). The tumors originated from the visceral pleura in 62 cases (79%) and from the parietal pleura in 18 cases (22%). The tumors were pedunculated in 66 cases (83%) and sessile in 20 cases (17%). Surgical resection with histologically free margins was accomplished in 76 of 79 patients (93%). The tumors were classified as benign in 51 cases (65%) and as malignant in 28 (35%). The factors that were significantly associated with malignant tumors were the presence of symptoms (p = 0.03), a mean diameter 10 cm or greater (p = 0.0004), fibrous adherences (p = 0.003), pleural effusion (p = 0.003), and a Ki67 10% or greater (p = 0.003). The median follow-up was 69 months (range, 1 to 315). Local recurrence occurred in 3 cases. The overall 5- and 10-year survival rates were 90% and 86%, respectively, and the mean survival time was 255 ± 15 months. There were no differences between the benign and malignant tumors. CONCLUSIONS The recurrence rates are low after surgeries for both benign and malignant solitary fibrous tumors of the pleura. However, the factors that are predictive of recurrence have yet to be specified and require additional immunohistochemical and genetic investigations.
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Affiliation(s)
- Guillaume Boddaert
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Patrice Guiraudet
- Department of General Thoracic Surgery, Pasteur Hospital, Nice Sophia Antipolis University, Nice, France
| | - Bertrand Grand
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Nicolas Venissac
- Department of General Thoracic Surgery, Pasteur Hospital, Nice Sophia Antipolis University, Nice, France
| | - Françoise Le Pimpec-Barthes
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Jérôme Mouroux
- Department of General Thoracic Surgery, Pasteur Hospital, Nice Sophia Antipolis University, Nice, France
| | - Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France.
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Ngampolo I, Rivière F, Boddaert G, Sanchez M, Gaspard W, Grand B, Le Floch H, Aguir S, Avramenko A, Niang A, Salles Y, Marotel C, Pons F, Margery J. Place de la vidéothoracoscopie dans le traitement précoce de la pleurésie infectieuse parapneumonique. Étude rétrospective monocentrique de 75 cas. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.164] [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: 11/28/2022]
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Ngabou UD, Dusaud M, Boddaert G, Grand B, Houlgatte A, Pons F. [Mediastinal localization of a growing teratoma syndrome: a case report]. Rev Pneumol Clin 2014; 70:248-251. [PMID: 24646785 DOI: 10.1016/j.pneumo.2013.12.007] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/14/2013] [Accepted: 12/14/2013] [Indexed: 06/03/2023]
Abstract
The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing teratoma syndrome. It consists of residual masses, usually retroperitoneal and, more rarely, thoracic, that appear during or after chemotherapy, although the tumor markers are normalized. We report a case of posterior mediastinal localization. This mediastinal localization is very rare, and because of the proximity to intercostal arteries, induces a risk of postoperative paraplegia.
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Affiliation(s)
- U D Ngabou
- Service de chirurgie thoracique, hôpital d'instruction des Armées Percy, 92140 Clamart, France.
| | - M Dusaud
- Service d'urologie, hôpital d'instruction des Armées du Val-de-Grace, 75005 Paris, France
| | - G Boddaert
- Service de chirurgie thoracique, hôpital d'instruction des Armées Percy, 92140 Clamart, France
| | - B Grand
- Service de chirurgie thoracique, hôpital d'instruction des Armées Percy, 92140 Clamart, France
| | - A Houlgatte
- Service d'urologie, hôpital d'instruction des Armées du Val-de-Grace, 75005 Paris, France
| | - F Pons
- Service de chirurgie thoracique, hôpital d'instruction des Armées Percy, 92140 Clamart, France
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Martinod E, Seguin A, Radu DM, Boddaert G, Chouahnia K, Fialaire-Legendre A, Dutau H, Vénissac N, Marquette CH, Baillard C, Valeyre D, Carpentier A. Airway transplantation: a challenge for regenerative medicine. Eur J Med Res 2013; 18:25. [PMID: 24059453 PMCID: PMC3750833 DOI: 10.1186/2047-783x-18-25] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022] Open
Abstract
After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization. In 1997, we proposed a novel approach: the use of aortic grafts as a biological matrix for extensive airway reconstruction. In vivo regeneration of epithelium and cartilage were demonstrated in animal models. This led to the first human applications using cryopreserved aortic allografts that present key advantages because they are available in tissue banks and do not require immunosuppressive therapy. Favorable results obtained in pioneering cases have to be confirmed in larger series of patients with extensive tracheobronchial diseases.
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Affiliation(s)
- Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Agathe Seguin
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Dana M Radu
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Guillaume Boddaert
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Kader Chouahnia
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Oncology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Anne Fialaire-Legendre
- Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, EFS Ile de France, Tissue Bank, Paris, France
| | - Hervé Dutau
- Assistance Publique-Hôpitaux de Marseille, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Nicolas Vénissac
- CHU Nice, Pasteur Hospital, Department of Thoracic Surgery, Nice, France
| | | | - Christophe Baillard
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Anesthesiology and Intensive Care, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Dominique Valeyre
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Pneumonology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Alain Carpentier
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
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Boddaert G, Riquet M. Reply. Ann Thorac Surg 2013; 95:2212-3. [DOI: 10.1016/j.athoracsur.2013.03.054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 02/26/2013] [Accepted: 03/25/2013] [Indexed: 11/26/2022]
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Martinod E, Uzunhan Y, Radu DM, Seguin A, Boddaert G, Valeyre D, Planès C, Carpentier A. [The lung]. Bull Acad Natl Med 2011; 195:1677-1685. [PMID: 22812170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lung transplantation is still the only curative treatment for end-stage pulmonary diseases. The results remain poor, however, because of the limited availability of lung donors, chronic rejection, and complications related to immunosuppressive therapy. The use of a bioartificial lung generated from autologous cells could offer a solution. We have demonstrated that in vivo epithelial and cartilage regeneration of the airways is feasible with the use of an aortic tissue matrix. Other studies show that in vitro and in vivo airway regeneration, respectively, can be obtained by using bio-engineering and heterotopic allograft implantation. A more complex challenge is the creation of an artificial lung Indeed, this would require the use of an elastic matrix that can promote regeneration of the different lung components (airways, alveoli, vessels) over a large surface area, thus allowing ventilation, blood perfusion and gas exchanges. Recent studies have demonstrated the possibility of in vitro and in vivo regeneration of lung tissue from autologous cells, and especially stem cells. This emerging research field is currently dominated by the use of decellularized lung matrices and autologous epithelial and endothelial cells. Implantation of such a recellularized matrix in animals has proved the feasibility of a functional bio-artificial lung. The first human transplantation of a bio-artificial lung should be possible within 10-20 years.
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Affiliation(s)
- Emmanuel Martinod
- Chirurgie thoracique et vasculaire, Assistance Publique-Hôpitaux de Paris, CHU Paris - Seine Saint Denis, Hôpital Avicenne, Pôle Activités cancérologiques spécialisées, Faculté de Médecine SMBH, Bobigny, Université Paris 13.
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Pierret C, Tourtier JP, Grand B, Boddaert G, Laurian C, de Kerangal X. Multiple tuberculous aneurysms of the aorta. J Vasc Surg 2011; 53:1720-2. [DOI: 10.1016/j.jvs.2011.01.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/24/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Margery J, Le Floch H, Rivière F, Ngampolo I, Boddaert G, Grand B, Mairovitz A, Minvielle F, Marotel C, Pons F, Vaylet F. [Role of chest physician in the management of patient with thoracic trauma]. Rev Pneumol Clin 2010; 66:239-244. [PMID: 20933165 DOI: 10.1016/j.pneumo.2010.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Accepted: 06/29/2010] [Indexed: 05/30/2023]
Abstract
Thoracic traumas are frequent and potentially fatal, because of the associated neurological and abdominal lesions. They are observed in car crashes, combat environments and urban terrorist bombings. The mechanisms of the traumatic injury are complex and account for the diversity of the lesions. The management of a chest trauma patient is a model of multidisciplinary collaboration where the chest physician can make a significant contribution.
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Affiliation(s)
- J Margery
- Service des maladies respiratoires, hôpital d'Instruction des Armées Percy, 92140 Clamart, France.
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Ngabou UD, Schilling T, Boddaert G, Grand B, Potet J, Arigon JP, Baccialone J, Pons F. [Catamenial pneumothorax with diaphragmatic lacerations]. Rev Pneumol Clin 2010; 66:272-275. [PMID: 20933170 DOI: 10.1016/j.pneumo.2010.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 06/30/2010] [Indexed: 05/30/2023]
Abstract
The authors describe a case of catamenial pneumothorax with diaphragmatic lacerations and partial liver herniation. It's a rare presentation of catamenial pneunmothorax. We analyse the diagnostic and surgical therapeutic.
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Affiliation(s)
- U D Ngabou
- Service de chirurgie thoracique et générale, hôpital d'instruction des Armées Percy, 92140 Clamart, France.
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Le Goudevèze S, Marchaland JP, Boddaert G, Versier G. Osteoid osteoma distal to a hip arthroplasty. Orthop Traumatol Surg Res 2009; 95:388-91. [PMID: 19628443 DOI: 10.1016/j.otsr.2009.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 03/07/2009] [Accepted: 03/31/2009] [Indexed: 02/02/2023]
Abstract
The authors report a case of osteoid osteoma distal to a hip prosthesis in a 56-year-old patient. This rare association was difficult to diagnose; at first, the pain seemed to be of mechanical origin, suggesting a delayed painful reaction to the prosthesis. The results of bone scan as well as the CT scan ones helped orient the diagnosis. Excision biopsy, using bone trephining, completed by an iliac bone auto-graft resulted in a cure with no residual instability of the prosthesis above the tumor. Bone scan with radio-isotopes to localize the lesion was particularly helpful in this instance to secure the final diagnosis.
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Affiliation(s)
- S Le Goudevèze
- Orthopaedic and Traumatology Department, Inter-Armies Begin Hospital, 69, avenue de Paris, 94163 Saint-Mandé cedex, France. sebastien
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Marchaland JP, Bey E, Paranque A, Ollat D, Boddaert G, Versier G. Stratégie thérapeutique initiale dans les pertes de substance distales du membre inférieur d'origine traumatique. À propos de 15 cas. ANN CHIR PLAST ESTH 2008; 53:14-21. [DOI: 10.1016/j.anplas.2007.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Accepted: 04/24/2007] [Indexed: 10/22/2022]
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