[Customized and non-customized French intrauterine growth curves. I - Methodology]. / Courbes de croissance in utero ajustées et non ajustées adaptées à la population française. I - Méthodes de construction.

OBJECTIVES: We developed intrauterine growth references, called EPOPé curves, in line with recommendations for screening of intra-uterine growth restriction issued in 2013 by the French College of Obstetricians and Gynecologists. POPULATION AND METHODS: Using the French Perinatal Survey (FPS) 2010, we adapted the methodology developed by Gardosi (1) to model intrauterine growth and its distribution and (2) to adjust for physiological fetal and maternal factors influencing fetal weight. Based on this model, 3 reference curves (unadjusted, adjusted for fetal sex, and adjusted for fetal sex, and maternal height, weight and parity) were proposed. We applied these models to births in the 2010 FPS and the French hospital discharge database (PMSI) in 2011-2012. RESULTS: Among singleton live births in the FPS and the PMSI, the model adjusted for fetal sex identified 3.2 and 3.3% of births below the 3rd centile respectively, and 10.0 and 10.2% below the 10th. In model adjusted for maternal factors, 4.0% of births from the FPS 2010 were reclassified, but population rates remained at 3.0 and 10.0%. CONCLUSION: This growth model is appropriate for French births, and allows for the implementation of a homogeneous definition of small for gestational age infants during pregnancy and at birth.

[Record linkage of hospital discharge data and first health certificates: a test in the Val d'Oise]. / Chaînage d'enregistrements de séjours PMSI aux premiers certificats de santé: un test dans le Val d'Oise.

BACKGROUND: Our objective was to test the feasibility of an indirect linkage of data on births from health certificates (HC) with hospital discharge (HD) data. METHODS: The linkage was carried out for live births between April 1st and June 30th, 2011 in six of the nine maternity units in the district of Val d'Oise. The HC and HD had 3284 and 3550 births registered during this period, respectively. Linkage was conducted using variables available in both sources: number of fetuses, baby's birth date, gender, maternity unit of birth, maternal age, municipality of residence, gestational age and birth-weight. Two linkage methods were tested: a deterministic and a semi-deterministic method and a probabilistic approach. The latter method calculates a probability estimate for the strength of the relationship between two linked observations related to the discriminatory power and the error rate of the matched variables. For cases that were linked despite discordance on some of the matching variables, random samples of observations were checked against both HC and HD records to compute rates of false matches. RESULTS: The deterministic and semi-deterministic method linked 92.5% and 85.6% of observations in the HC and HD, respectively. The probabilistic method achieved a linkage rate of 99.6% for HC and 92.7% for HD. Cases only linked by the probabilistic method were more often preterm and had low birth-weight. Cases matched using the probabilistic method only had an error rate of 0.4% with 95% CI [0.2-0.6%]. CONCLUSION: Common items in the HC and HD make it possible to achieve a high rate of linkage. The probabilistic method links more births and, in particular, those at higher risk, and error rates were low.

[Evaluation of a perinatal network using the first certificates of health]. / Évaluation d'un réseau périnatal à partir des premiers certificats de santé

OBJECTIVE: To describe the methodology for continuous reporting of perinatal indicators in Maternité en Yvelines et Pays Associés (MYPA) network, and the main results for its evaluation. To discuss the implications for practice in a perinatal network. MATERIAL AND METHODS: CoNaissance 78 program is a collaboration between MYPA network, Conseil général des Yvelines, ARS Île-de-France and U953 Inserm unit. Continuous recording of data is produced using the first certificate of health (PCS) of infants born in the network maternities, an additional health certificate including data about severe maternal morbidity, perineal tears and episiotomies, and a stillbirth certificate including all cases of fetal deaths and medical termination of pregnancy from 22weeks of gestation. Description of the population and obstetric practices with comparison between the network maternities covers the period from 2008 to 2011. RESULTS: The analysis includes 79,232 births. The used variables had a missing data rate below 5%. The mean maternal age at delivery was 30.9, women aged 35years or above accounting for 23.2% of deliveries (from 17.1 to 32.8% according to the maternity, P<0.001). Nullipara rate was 42.5% (from 36.6 to 50% according to the maternity, P<0.001) and multiple pregnancies rate was 1.8% (from 0.3 to 3.4% according to the maternity, P<0.001). Mode of onset of labor was spontaneous in 66.1% cases (from 55.5 to 72.9% according to the maternity, P<0.001), induced in 21.5% cases (from 16.9 to 30.8% according to the maternity, P<0.001) and a planned cesarean section was performed in 12.4% cases (from 8.4 to 19.6% according to the maternity, P<0.001). The global mean rate of cesarean sections was 24.3% (from 18.4 to 29.6% according to the maternity, P<0.001). The cesarean section rate was in a selected low risk group was 14.7% (from 11.4 to 20.2% [P<0.001] according to the maternity). The episiotomy rate was 26.1% (from 16.3 to 43.6% [P<0.001] according to the maternity). The rate of very preterm neonates born alive inside a tertiary center was 70.8%. CONCLUSION: This program allowed to observe a large disparity in practices, and highlighted significant shortcomings in the organization of in utero transfers to the tertiary center for very preterm births.

[Intra-osseous ganglion cyst of the carpal bones. A review of the literature underlining the importance of systematic computed tomography]. / Kystes synoviaux intraosseux du carpe : intérêt de la tomodensitométrie systématique pour l'évaluation du risque fracturaire.

The intraosseous ganglion cyst (IOGC) is a benign and lytic bone tumor affecting mostly the metaphyseal and epiphyseal regions of long bones. Its location on the short bones, including the carpal bones has been little reported in the literature. Our review of the literature shows consensus about the surgical techniques to use, but there is currently no real consensus about its pathophysiology, and its diagnostic work-up. Complications related to this lesion (mainly the risk of pathologic fracture) are potentially serious, and can cause irreversible damage. They therefore require accurate assessment to guide the choice of medical or surgical treatment, including a CT scan, which - we believe - is essential.

[Interest and reliability of frozen section biopsy in the treatment of skin tumors]. / Intérêt et fiabilité de l'examen extemporané dans la prise en charge des tumeurs cutanées.

INTRODUCTION: Association of surgical treatment combined to frozen section biopsies appears to be one of the most appropriate therapeutic solution for the treatment of skin carcinomas. We report our experience on 269 tumors assessed with frozen sections. Our goal was to first study the benefit of a one-time surgical approach, then to better target the tumors eligible for this examination and finally to number the difference between frozen section and final histology studies. MATERIALS AND METHODS: This is a retrospective analysis of 269 tumors, operated on an outpatient basis with frozen section followed later by a final histology study. All being performed by the same team of surgeons and pathologist. Only previously biopsied and diagnosed basal cell or squamous cell tumors were included. The recorded data were: location of tumor; histological type; involved margins; number of cuts; differences between frozen section and final histological studies, which conduct to a two-time surgical approach; number of tumors for which frozen section was impossible during surgery and that lead to a two-time surgical approach; type of reconstruction; number of recurrence. RESULTS: The follow up was 48 months (26.6 to 78.1). Histogical analyses were carried on basal cell carcinoma (92%), squamous cell carcinoma (8%) with a topographic distribution mainly in face and neck (72%). Of the 269 tumors excised, 207 representing 77% had a sufficient safety margin, 62 representing 23% had at least one invaded bank that required further surgical resection. We found seven cases of two-time surgical approach. In three cases, it was secondary to medical decision because of a technical difficulty of histologists. In one case, histological diagnosis can't be obtained by frozen section study. In three cases, we found a difference between frozen section and final study. CONCLUSION: The benefit provided by the frozen section takes its value in the treatment of face and neck tumors, whose optimal margins are sometimes difficult to obtain and minimal scar ransom necessary. A one-time surgery was made possible to us thanks to this fast examination. The low rate of second surgery and recurrence allows us to demonstrate the reliability of this technique.

[Study of skin retraction applied to the treatment of skin tumors. Mapping of the human body]. / Étude de la rétraction cutanée appliquée à la prise en charge des tumeurs cutanées. Cartographie du corps humain.

SUBJECT: Skin, the main organ of the human body, is equipped with own biomechanical characteristics, highly variable depending on intra-individual factors (location, weight status, dermatological diseases…) and interindividual (age, sex…). Despite some recent cutometric studies, our review of the literature shows that there is no currently reliable analytical model representing the biomechanical behavior of the skin. Yet, this is a central issue in dermatology surgery, especially in the treatment of skin tumors, for the proper observance of surgical margins. PATIENTS AND METHODS: We studied prospectively on 75 resection specimens (about 71 patient(s)), for the treatment of skin lesions tumor suspicious or known malignant or benign. Room dimensions were measured before and 5 minutes after excision, leading us to calculate a ratio of retraction of the skin surface. This retraction was correlated with age, gender, tumor type, and anatomic location of the site of excision. RESULTS: The power of retraction of the skin varies significantly by region of the body. It is maximum in the upper limb (hand excluded) and in the cervical region. At the cephalic region, skin of the ear and periorbital skin have capacities of important early retraction. Unlike the lower limb (foot excluded), the back skin of the nose and face appear to be a minimum of shrinkage. Age also seems to change on that capacity shrinkage, sex would have no influence. CONCLUSION: Our study confirms the variations in the ability of skin retraction based on a number of factors. In dermato-oncology, that power retraction could cause significant differences between clinical surgical margins and final pathologist margins. We believe it must be taken into account by the couple surgeon-pathologist, especially in the context of invasive and/or recurrent tumors.

[Hammer hypothenar syndrome: review of the literature and case report]. / Le syndrome du marteau hypothénarien: analyse de la littérature et cas clinique.

Hypothenar hammer syndrome is a rare disease first described by Conn et al. in 1970. It groups together symptoms of chronic microtraumatism to the ulnar artery or its superficial palmar branch against the hamate. Manual workers using vibrating tools are the most affected by this. Diagnosis is made by echodoppler, while arteriography is the gold standard for establishing the treatment plan. Hypothenar hammer syndrome may lead to severe complications secondary to ischemia and to embolic events resulting from delayed diagnosis or maltreatment. There is no real consensus as to the place of medical or surgical treatments. Medical treatment consists of eliminating favorizing factors and long-term antiplatelet aggregation treatment. Surgical treatment depends on the vascular lesions: simple arterial ligation, resection of the thrombosed arterial segment and end-to-end anastomosis, or revascularization using a pontage venous or arterial graft. Some authors suggested an associated thoracic sympathectomy. The diagnosis must be made early; the choice of treatment must be targeted at preventing serious embolic complications.

[Hypothenar eminence]. / Eminence hypothénar.

The hypothenar eminence is of great surgical interest yet its complex anatomy is yet to be fully discovered. This review focuses on: the osteoligamentous floor and topography of the Guyon's canal and the carpal ulnar neurovascular space. The canal under the Pisohamate ligament must be individualized. It corresponds to the zone 2 of Shea and McClain where the deep branch of the ulnar nerve is particularly vulnerable. Usually described as a hole, it is a real canal that circumvents the hamulus; the hypothenar muscles are extremely variable. The short abductor of the little finger may be harvested for opposition transfer but its absence penalizes abduction of the little finger if an independent flexor digiti minimi brevis inserts on the head of the fifth metacarpal; the termination of the ulnar nerve distribution to the hypothenar muscles and medio-ulnar anastomoses. The ulnar artery, its close relationship with the hook of the hamate and its variable course that may put it at risk during endoscopic carpal tunnel release. Finally, blood supply of fat pads and skin and their use as flaps to cover the palm and fingers.

[Primary essential cutis verticis gyrata: Case report and literature review]. / Cutis verticis gyrata primitif essentiel : cas clinique et revue de la littérature.

INTRODUCTION: Cutis verticis gyrata (CVG) is a rare and slowly progressive deformity of the scalp with thick gyrated skin folds and ridges which are similar to gyri of the brain cortex. Those folds can lead to local skin infections, to a social and cosmetic complain. CVG can be classified into two forms: primary (essential and non-essential) and secondary. To date, fifteen operated cases of primary essential CVG have been reported in the medical literature. CASE REPORT: We report the case of an 18 year-old male patient with a primary essential CVG. There were several large skin folds in the sagittal axis on the vertex region, and in the coronal axis on the occipital region. He did not present any cutaneous complication. His main complains was the unaesthetic aspect of his scalp with a psychological complex. The disease had occurred during puberty. We present the excision pattern and the results with a six months follow-up. CONCLUSION: CVG can be treated surgically with resection of the thickened excess skin in coronal and sagittal axis. Scalp lift must be effective all over the different areas of the scalp. The scalp flaps must have a reliable vascularisation. Combined incisions of the galea help to treat the residual folds. The excision pattern must be reproductible, as this disease is progressive.

[The use of the "spare-parts tissue bank" concept in emergency hand surgery]. / Utilisation des << tissus-banque >> en chirurgie de la main d'urgence.

INTRODUCTION: In the case of multidigital hand trauma, the tissue of the amputated parts can be used for the reconstruction of the defected tissue localized on the other fingers. PATIENTS AND METHODS: A series of seven patients has been reviewed in this paper; the authors illustrate the different possibilities of using the "spare-parts concept" in the emergency hand trauma surgery. RESULTS: The functional results are presented. DISCUSSION: The different techniques of reconstruction using the "spare-parts concept" are discussed. CONCLUSION: In the cases of multidigital lesions, the surgeon should choose the best opportunity to use the tissue of the amputated digits, or the non-conservable ones, to reconstruct the neighboring preserved segments.

Histological staging and Dupuytren's disease recurrence or extension after surgical treatment: a retrospective study of 124 patients.

Dupuytren's disease has a high rate of recurrence after treatment. In this study we have assessed the usefulness of histological staging in the prediction of recurrence. We have also verified whether there is a correlation between histological staging and features of Dupuytren's diathesis. We studied 139 hands in 124 Caucasian patients treated between 1997 and 2004. There was a significant difference in the recurrence rate between the three histological types (P = 0.04). Histological staging was independent of features of Dupuytren's diathesis. This study confirms that histological staging is a reliable method for predicting recurrence. However, it should be used in association with clinical data to determine precisely the prognosis of patients suffering from Dupuytren's contracture.

[Constitutional asymmetries in aesthetic breast augmentation: incidence, postoperative satisfaction and surgical options]. / Les asymétries constitutionnelles en chirurgie d'augmentation mammaire esthétique: incidence, satisfaction et applications chirurgicales.

INTRODUCTION: The clinically observable, constitutional breast asymmetries are frequent and physiological in the general population. Although there has been a preponderance of literature concerning breast augmentation, a conspicuous lack of data exists regarding the preoperative breast and chest wall asymmetries seen in the patient seeking consultation for aesthetic breast augmentation. These asymmetries can lead to postoperative dissatisfaction in patients. MATERIALS AND METHODS: An independent plastic surgeon analysed the data of 200 patients who had a primary aesthetic breast augmentation. The mean follow-up was 36 months. All patients had pre- and postoperative standardized pictures of the anterior chest wall. The clinical examination was achieved using an original evaluation form. Patients were also asked to fill an exhaustive satisfaction form. Breasts and chest wall asymmetries were diagnosed by clinical examination and photographic analysis. Mastopexy-augmentations, breast reconstructions, breast malformations (tuberous breasts and Poland syndrome) and patients with incomplete data were excluded from the study. Stastical analysis was done using SPSS software version 15. RESULTS: There were 77% of chest wall and breast asymmetries and 69,5% of breasts asymmetries (26,5% of breast mound volume asymmetry and 62,5% of shape asymmetry). An isolated chest wall asymmetry was found in 17% of patients. Scoliosis was the main cause of asymmetry (52,9% of chest wall asymmetries) as it is often associated with chest wall rotation, chest wall depression, submammary depression or rib asymmetry. Patients often noticed an asymmetry postoperatively (28%). Among the patients complaining from a postoperative asymmetry, 83,3% had a constitutional breast or chest wall asymmetry. Asymmetry was the third cause of dissatisfaction and the third argument for revision surgery (after volume dissatisfaction and ptosis). Thirty per cent of patients asking for a surgical revision and 35.3% of unsatisfied patients complained about asymmetry, which was preoperative in 83.3% of cases. CONCLUSION: The asymmetry rate of our study is compared with the others studies found in the literature. In the daily practice, asymmetry can be diagnosed by a complete clinical examination and standardized chest wall pictures. Patients with constitutional asymmetry should be educated, helping to increase postoperative satisfaction. The authors propose and discuss a surgical pattern for the handling of the different types of asymmetries in breast augmentation.

[Surgical management of traumatic ear amputations: literature review]. / Prise en charge des amputations traumatiques de l'oreille : revue de la littérature.

Traumatic ear amputation (TEA) is a complete avulsion of a part or of the total auricular tissue. TEA are rare (only 74 cases have been described in the literature) and their handling is complex. The surgeon's objective is to obtain the best cosmetic result without demolishing the auricular area in order to allow future ear reconstruction in case of replantation failure. Many techniques of ear replantation have been described in the literature during the last 30 years: microsurgical replantation, pocket techniques and reattachment techniques. Microsurgical replantation should be achieved every time it is possible. When it is not possible, the surgeon can choose between ear reattachment and a pocket technique according to two clinical features: the size of the amputated part and the involvement of the ear lobe. Ear reattachment can be achieved when the amputated part is smaller than 15 mm or when amputation involves the earlobe. Pocket techniques, which are appropriate for the replantation of the auricular cartilage, can be used when the amputated part is bigger than 15 mm and does not comprise the earlobe.

[Planned reconstruction after broad carcinological demolition of the face: case report]. / Reconstruction planifiée après large démolition carcinologique de la face: à propos d'un cas.

UNLABELLED: The authors present their approach in face reconstruction after carcinological demolition. CASE REPORT: A 40-years-old patient presented an epidermoid carcinoma starting at the level of the right jawbone, few differentiated, massively destroying the roof of the maxillary sinus with subcutaneous and cutaneous infiltration in front and extension to the orbit. A broad right hemifacial right amputation was decided with ocular exenteration, cutaneo-palpebral sacrifice, parotidectomy with conservation of the facial nerve and standard cervical neck. After study and 3D simulation the reconstruction was carried out by an osteocutaneous parascapular flap using the external columna of the scapula for the repair of the lower orbital edge in order to accomodate an epithesis. CONCLUSION: We think that the planning step and preoperative three-dimensional measurement is of primary importance. It defines the size and type of flap to be taken in order to rebuild as well as possible the face while respecting the aesthetic units.

[Clinodactylies: delta phalanx and Kirner deformity]. / Les clinodactylies: phalange delta et déformation de Kirner.

Clinodactyly is a symptom defined as an excessive angulation of a finger in the radio ulnar plane. The authors present the various etiologic patterns of clinodactyly, including delta phalanx and Kirner's deformity. Surgical techniques, indications and ideal timing for surgery are detailed.

[Perilunate dislocations and fracture-dislocations of the wrist, a review of 14 cases]. / Luxations et fractures-luxations périlunaires du carpe, étude rétrospective d'une série de 14 cas.

OBJECTIVES: We report a retrospective series of 14 dislocations or perilunate fracture-dislocations. The results of our series are compared with the data of the literature and we discuss epidemiology, types of lesions, surgical treatment, complications and prognosis of this pathology. METHODS: The series included seven pure dislocations and seven fracture-dislocations including three trans-scapho-lunate forms (including one Fenton's syndrome). The displacement of all these lesions was posterior. The mean age was 35 years. Sixty-four percent were manual workers. All 14 patients had undergone surgical treatment through a dorsal approach in the first seven days following the injury. They were reviewed clinically and radiologically with a mean follow-up of 25 months. RESULTS: The average Cooney functional score was 72/100 with two excellent, six good, four fair and two poor results. Average flexion-extension motion arc was 74%, the grip strength was 77% compared to the other wrist. Persistent wrist pain was almost constant. One carpal instability was observed and one patient required a four-corner arthrodesis for SLAC wrist. Eighty-five percent of all patients were employed at least. CONCLUSIONS: Early diagnosis and anatomical reduction can provide satisfactory functional results. Emergency surgical treatment is required. We prefer a dorsal approach and we do not perform primary closed reductions.

[Necrotizing fasciitis: complication of patient positioning?]. / Dermohypodermite bactérienne nécrosante avec fasciite nécrosante : complication d'une installation opératoire ?

Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. It disseminates along fascias with a mortality sometimes within 18 hours. The average mortality, reported in the literature, is about 30%. A 65-year-old man, with a history of Vaquez disease (under hydroxurea) and a smoke addiction, had an epidermoid carcinoma of the left vocal cord (T2 N0 M0). The cancer treatment consisted of a functional lymph node excision, followed by tracheotomy then by partial laryngectomy. At the end of the intervention, after removal of operative fields, it was noticed that the Montandon cannula had slid and was between the medial side of the left upper limb and the lateral side of the chest. There was a cutaneous imprint with ecchymosis on the route of the cannula. At the second postoperative day, a necrotizing fasciitis quickly developed on the left side of the chest, the medial side of the left upper limb, and the left hip without infection of the operating site. An Escherichia coli was identified in tracheal secretions and operative samples. The presumed hypothesis of this necrotizing infection is the cutaneous contamination of the thoracic wall by tracheal secretions colonized by E. coli, whose penetration was induced by the cutaneous traumatism due to the cannula. We remind, by analyzing this unusual case, the caring principles one of which diagnosis and the surgical excision must be as premature as possible. We insist on the elementary measures of protection of the support points and the good binding of cannulas.

Surgical treatment of the boxer's fracture: transverse pinning versus intramedullary pinning.

The purpose of this study was to compare the surgical treatment of fractures of the little finger metacarpal neck, or "Boxer's" fractures, by transverse pinning and intramedullary pinning. Thirty-six patients with fracture of the neck of the fifth metacarpal were included in a prospective comparative randomised study. A palmar splint was applied for 1 week after both procedures. Patients began physiotherapy three times per week for 30 days. The patients were evaluated clinically six times after surgery, up to the 90th day, with X-ray assessment on days 8, 45 and 90. The study showed that intramedullary pinning gave better functional outcomes than transverse pinning, although the former was more technically demanding.

[Traumatic pseudo-boutonniere of the metacarpophalangeal joint of the little finger. Case report and review of the literature]. / Pseudoboutonnière traumatique de l'articulation métacarpophalangienne du cinquième doigt: a propos d'un cas et revue de la littérature.

Dislocation of the extensor tendon over the metacarpophalangeal joint is common among patients with rheumatoid arthritis. Patients without arthritis are exceptionally involved. The authors describe a new case of traumatic boutonniere-like of the metacarpophalangeal joint of the little finger. This lesion is a rarely, only eleven cases are described in literature. Patients are usually young adults and dislocation is related to a direct axial trauma on their fifth metacarpophalangeal joint. Diagnosis is clinical and relies on an incomplete active extension of the metacarpophalangeal joint, secondary to the dislocation of the extensor apparatus. Diagnosis is often delayed the lesion remaining unnoticed with the occurrence of others hand lesions. Proper treatment is surgery, based on suturing side to side both extensor digiti minimi and common extensor tendon over the fifth metacarpophalangeal joint. Results are excellent, with a complete range of motion and the absence of recurrence.

[Heterotopic digital transplantation in an 80-year-old man]. / Replantation digitale hétérotopique chez un homme de 80 ans.

The authors report a case of amputation of the first, second and third fingers of the left hand in an 80-year old man. As the thumb was not replantable, a pollicization by hetero-replantation of the index was performed as an emergency. With a 1-year follow-up, the functional result was satisfactory. Analysis of the case report again shows that in the case of thumb amputation, hetero-replantation according to the principles of "finger-bank" is the solution of choice and demonstrates its feasibility in the elderly. The authors discuss the recovery of sensation.