RhBMP7 use for treating scaphoid non-union: 5 cases assessed at 10 years' follow-up.

The scaphoid is the most common non-union site in the wrist. Fixation with vascularised or non-vascularised autograft is the gold standard when it comes to treating these non-unions. But, what can we offer if the autograft fails? Using osteoinductive proteins in difficult cases of long bone non-union yields good results. However, only a few studies have been published on their use for scaphoid non-union. In our study, five patients with an average age of 32 years (ranging from 21 to 44 years) with old non-union (more than 24 months) of the scaphoid were treated after autograft treatment had failed. The procedure consisted of reaming the non-union site, then adding bone autograft combined with BMP-7 (Osigraft®) in the defect and fixing it all with a screw or K-wire. Postoperative immobilisation was prescribed. Only one patient achieved bone union (20%) despite an average follow-up of 10 years (80-143 months). The average flexion-extension loss was 16.6° (0-30) relative to the contralateral side. The average strength deficit was 450 grams (0-2000) for pinch and 12.1kg (0-29) for grip compared to the contralateral side. Self-assessment questionnaires had an average PRWE at 28.9 (10.5-49) and an average QuickDASH at 28.6 (9.09-61.36). Our study could not demonstrate any real benefit of using BMP-7 for treating old scaphoid non-union despite an elevated cost. Further research is needed to look at other treatment approaches, for instance, the use of new scaffolds combining VEGF and BMP.

[Limb necrotizing soft tissue infection (NSTI) and necrotising fasciitis: A bicentric study between 2000 and 2017 on the quality of life and functional impact]. / Atteinte des membres dans les DHBN-FN : étude bicentrique entre 2000 et 2017 sur la qualité de vie et impact fonctionnel.

INTRODUCTION: Limb necrotising soft tissue infection and necrotising fasciitis surgical debridement results in significant soft tissue losses. The purpose of this study was to evaluate the functional impact and the quality of life of survivors. PATIENTS AND METHODS: This bicentric retrospective study included 62 patients treated for limb necrotising soft tissue infection and necrotising fasciitis (NSTI-NF) between 2000 and 2017. Demographic, clinic, biologic and surgical data were found in Patients Medical Records. Survivors at the moment of data collection (2018) were met; their quality of life was assessed using SF-36, DLQI, BSHS-B scores and their active joints motions were measured using a goniometer. RESULTS: Twenty-one patients (87.1% of the living patients at this moment) were assessed. For the joint above the injury, mean loss of flexion was 9.19% and 5% for extension whereas for the joint under the injury, mean loss of flexion was 37.65% and 48.6% for extension compared to non-injured side. Mean quality of life scores were: SF-36p: 45.88, SF-36m: 51.31, DLQI: 10.48, BSHS-B: 105.81. The statistical analysis was not able to establish a correlation between loss of motion and quality of life. CONCLUSION: We have not found a relationship between loss of joints motions and long term quality of life for those patients. High excised body surface area and high length of stay are correlated with high DLQI and thus a lower quality of life.

[Should surgeons keep performing drainage after breast reduction?] / Faut-il encore drainer les réductions mammaires ?

OBJECTIVE: Despite the absence of "evidence-based medicine", the use of closed suction drainage in breast surgery is currently the standard practice. Its goal is to minimize the amount of fluid at the operation site, the dead space that can involve postoperative complications. The purpose of this study is to demonstrate that with or without drainage the complication rate is unchanged. METHODS: We conducted a retrospective and comparative study of two groups of breast reduction with and without drainage. Every complication has been recorded and statistically analyzed: seroma and hematoma, infections, wound breakdown, skin flap or nipple-areola complex necrosis, fat necrosis and reoperation. RESULTS: A total of 138 breast reductions were performed (37 drained patients and 32 non-drained). Data collection of complications was done on average 10months after the operation (1-15). There was no statistical difference between the two groups regarding the complication rate. Our results confirm the ones found in the literature. CONCLUSION: Except for specific cases (e.g. gigantomasty), this study demonstrates that after breast reduction, drainage is not appropriate. Drains do not reduce postoperative complications and can increase hospitalization length of stay (inducing higher costs). Furthermore, it is often source of pain, anxiety and discomfort for patients.