[State of affairs and optimization of plastic surgery training in France]. / État des lieux et optimisation de la formation à la chirurgie plastique en France.

BACKGROUND: Concerns have been growing for several years among masters, as to the quality and quantity of training in plastic surgery in France. They are mainly based on the reduction in the working time of residents, the appearance of new residents from generation Z to be trained, and finally the multidisciplinarity of plastic surgery in the current context of overspecialization of training center. METHODS: In order to objectify these concerns, a survey was carried out among French residents and young heads of plastic surgery to assess their training in the specialty since 2019. We then looked in the law for possibilities to alleviate these concerns. RESULTS: All the respondents think that their training in the specialty is incomplete, and few of them have been able to supplement it with rotations outside the subdivision or visits from private practitioners. However, in the law, it is possible to carry out: three residents rotations outside the subdivision, clinics rotations and international exchanges. DISCUSSION: At the end of this analysis, we propose three solutions to optimize training in plastic surgery in France: a system of exchange of residents, the opening of residents rotations in clinics, and finally, to facilitate the realization of operating aids with private practitioners. CONCLUSION: With these solutions, the field of training for residents could extend from one region to the whole of France. These solutions could easily be applied to other specialties, surgical and medical.

Antibiotic therapy in pediatric acute appendicitis: Compliance with local protocol to reduce antibiotic overuse.

PURPOSE: Acute appendicitis is one of the commonest surgical emergencies in pediatrics. Treatment usually consists of a combination of surgery and antibiotics. The present study was designed to assess compliance with our local antibiotic protocol and analyse the consequences of non-compliance. METHODS: Children presenting with acute appendicitis between 2015 and 2017 were included in this study. The diagnosis of acute appendicitis was confirmed during surgery. Data concerning the antibiotic therapy received and infectious complications were reviewed. RESULTS: A total of 142 children with acute appendicitis were included. Antibiotic therapy complied with the protocol in 27.4% of cases, while an excessive duration of antibiotic therapy was observed in 65% of cases. A total of 270 days of non-recommended antibiotic therapy was noted; 32% of patients received a non-recommended combination of antibiotics. The infectious complications rate was 12.8% in the group of patients receiving appropriate antibiotic therapy, and 11.6% in the group with non-compliance to the protocol. No statistically significant difference between the groups was found (P=0.85). CONCLUSION: Poor compliance with the antibiotic guidelines for appendicitis resulted in antibiotic overuse with no benefit in terms of anti-infective efficacy. Better information for the medical team and repeated evaluation of our practices are essential.