[Pre-iliac tumor mass syndrome: An atypical rheumatoid nodule]. / Syndrome de masse tumorale pré-iliaque : un nodule rhumatoïde atypique.

Rheumatoid arthritis (RA) is a polymorphous chronic inflammatory disease that is common in general population and is responsible for the occurrence of subcutaneous or visceral rheumatoid nodules. Their typical clinical presentations and localizations do not generally pose any diagnostic or therapeutic problem. We report here an atypical fistulized presentation of an unusual iliac rheumatoid nodule in a 65-year-old female patient. The evolution was favorable without recurrence at 6 months after complete surgical resection and appropriate antibiotherapy.

Methylmetacrylate (PMMA) cranioplasty technique: Technical interest of intraoperative modeling and review of the literature.

Reconstruction of bone loss in the cranial vault may be necessary for functional or aesthetic reasons following trauma, decompression craniectomy, or craniofacial malformations. Many techniques have been described in the literature, using various materials, each with its own advantages and drawbacks. Reconstruction with polymethylmetacrylate cement has the advantage of a durable result and relative ease of use. In this article we present our cement cranioplasty technique through 4 clinical cases of cranial vault reconstruction, by direct intraoperative modeling on the bone defect. This accessible, effective method, applicable to all sizes of defect, remains an attractive option in the arsenal of techniques available today.

Blast injury of the hand related to warfare explosive devices: experience from the French Military Health Service.

INTRODUCTION: The objective was to report on the experience of the French Army Health Service in the management of blast injury of the hands related to warfare explosive devices. METHODS: A retrospective study was conducted in the Percy Military Hospital (role 4 medical treatment facility) among French soldiers who presented with a combat-related blast injury of the hand between 2002 and 2018. The functional result was assessed by the disabilities of the arm, shoulder and hand (DASH) and the Orthotics and Prosthetics User Survey (OPUS, upper extremity functional status) scores. Proximal amputations (PAs) and distal amputations (DAs) were distinguished for the analysis. RESULTS: Fifteen patients with a mean age of 31±8 years were included. They totalised 20 blasted hands. There were 16 traumatic amputations: 8 in each of the PA and DA groups. Twelve patients had additional injuries, four of which were polytraumatic. Skin closure time and flap use were higher in the DA group. Only one thumb reconstruction was performed. At a mean follow-up of 6.5±4 years, the number of amputees wearing a prosthesis was higher in the PA group. The mean DASH and OPUS scores were 35.5%±24.0% and 64.0%±19.0%, respectively, with no difference between the two groups. CONCLUSION: The severity of hand blasts related to warfare explosive devices requires the systematic application of damage control surgery. PAs are frequent and secondary reconstruction options are limited. The functional result is poor and similar between proximal and distal amputees.

Medical and surgical management of lower extremity war-related injuries. Experience of the French Military Health Service (FMHS).

Lower extremity war wounds are characterized by high-energy trauma occasioning loss of complex and pluritissular substances. The support pipeline put into place by the French defense health service (SSA) is designed to rapidly evacuate the injured person from the scene of injury to mainland France, following initial surgery in the framework of a sequential tactic known as "Damage Control Surgery". This strategy is aimed at stabilizing the traumatized individual and enabling his evacuation. Patients are subsequently treated in a restorative surgery unit in a Hôpital d'Instruction des Armées (HIA), a level 1 trauma center (HIA Percy, HIA Saint-Anne) Cooperation between the plastic and orthopedic surgery specialties is essential insofar as it allows for surgical optimization aimed at saving the limb while restoring function to the greatest possible extent. Notwithstanding painstaking application of this common strategy, septic pseudoarthrosis remains the principal and most feared complication, at times rendering impossible any therapeutic solution other than amputation. Whether prosthetic or non-prosthetic, the rehabilitation provided by doctor/physiotherapists is conducive to patients' social and professional reintegration. The nation's duty to assist its wounded veterans is carried out with determination by the French defense ministry. As concerns lower extremity war wounds, the authors detail the reconstruction doctrine based on the 6/7/8/9 rule, in accordance with which strategies for repair of soft tissue and reconstruction of the lost bone substance have been developed.

[The "racket-like" flap: Method to increase the reliability of the sural neuro-cutaneous flap]. / Le lambeau neurofasciocutané sural : fiabilisation par le prélèvement d'un lambeau en raquette.

We realized a retrospective study from 2003 to 2018 comparing two surgical techniques of neuro-fascio-cutaneous sural flap harvesting to improve their reliability: the "vascular pedicle tunneling" method and the "racket-like" flap method. There are 35 flaps in this series from lower distal limb reconstruction: 21 "racket-like" flaps and 14 "tunneling-pedicle" flaps. There were no partial or total necrosis case in the "racket-like" flaps group. Our technique reduces covering failure due to partial or total necrosis risk with a statistically significant impact. We propose to extend the "racket-like" technique to every fascio-cutaneous flap available.

Grafting both acute wound site and adjacent donor site with the same graft: an easy and safe procedure to improve healing and minimize pain in elderly and bedridden patients.

In harvesting skin to cover the defect caused by a burn, a second wound is created, the donor site wound. We propose an alternative method to manage the donor site: taking a split-thickness skin graft (STSG) from a donor site adjacent to the burn wound to be treated, and meshing at a 3:1 ratio to cover both sites at once. The main objective of this study is to evaluate the effectiveness of covering both burn wound and adjacent donor site with the same STSG in elderly and bedridden patients. We retrospectively reviewed the medical records of 6 patients over 60 years old or/and bedridden presenting with a small burn wound who underwent STSG of both burn wound and adjacent donor site between April 2016 and November 2016 in the Department of Plastic Surgery and Burn Treatment at Percy Military Hospital (France). Their data were compared with data of five patients who had undergone the usual STSG procedure during the same period. There was a statistically significant difference between patients who underwent adjacent STSG procedure and those who underwent usual STSG procedure in healing time (days) mean (SD) (7,33 ± 1,03 vs. 16,2 ± 0,83; p = 0,007) and Numeric Rating Scale pain mean (SD) at day 2 (0,33 ± 0,33 vs. 2,4 ± 1,35; p = 0,04). Grafting both acute burn wound and adjacent donor site with the same graft seems to be an easy method to improve healing and minimize pain in the STSG donor site in elderly and bedridden patients.

Lors du prélèvement de peau mince pour couvrir une plaie causée par une brûlure, une seconde plaie est créée, le site donneur. Voici une méthode alternative pour la gestion du site donneur: prélever une greffe de peau mince GPM à partir d'un site donneur adjacent à la brûlure, l'expandre avec un ratio de 3:1 pour couvrir les deux sites à la fois. Ici l'objectif principal est d'évaluer l'efficacité de la couverture simultanée d'une petite brûlure et du site donneur adjacent avec la même GPM chez les patients âgés et alités. Nous avons étudié rétrospectivement les dossiers de 6 patients traités par couverture simultanée de la brûlure et du site donneur adjacent avec la même GPM entre avril 2016 et novembre 2016 dans le Service de Chirurgie Plastique de l'hôpital militaire Percy (France). Les données ont été comparées à un groupe similaire de patients qui ont subi une procédure habituelle durant la même période. Il y avait une différence statistiquement significative entre les patients qui ont subi une procédure de GPM du site donneur adjacent et ceux qui ont subi une procédure habituelle sur la durée (jours) moyenne (écart-type, SD) de cicatrisation (7,33 ± 1,03 vs 16,2 ± 0,83; p = 0,007) et de la douleur sur l'échelle numérique au jour 2 (0,33 ± 0,33 vs 2,4 ± 1,35; p = 0,04). Greffer la plaie liée à la brûlure aiguë et le site donneur adjacent avec une même GPM semble être une méthode simple pour améliorer la guérison et minimiser la douleur du site donneur.

What is the association between quality of treatment for depression and patient outcomes? A cohort study of adults consulting in primary care.

BACKGROUND: The association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The main objective of this study was to examine the association between receiving at least one minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6- and 12-months. Associations with receiving pharmacotherapy and/or psychotherapy and the role of severity of depression were examined. METHODS: This cohort study included 908 adults meeting criteria for previous-year MDE and consulting at one of 65 primary care clinics in Quebec, Canada. Multilevel analyses were performed. RESULTS: Results show that (i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; (ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and (iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months. LIMITATIONS: Measures are self-reported. Participants were recruited at different stages over the course of their MDE. CONCLUSIONS: This study shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions, but that those with more severe depressive symptoms are more likely to receive adequate treatment and improve across time.

[The risk of iatrogenic burn must not be forgotten while struggling against nosocomial infection: rules and precautions in operating rooms]. / Prévention des infections nosocomiales et brûlures iatrogènes : rappel des règles et précautions à respecter au bloc opératoire.

Accidental burns in the operating room are hopefully rare events, but it could happen during any surgical procedure. To reduce the nosocomial infection, the use of alcohol-base products is recommended by all the recent guidelines. Yet these inflammables products represent a potential danger if they are not carefully employed, and the surgeon's responsibility can be involved. We therefore thought it would be interesting to show the benefit provided by such products in terms of wound infection and skin preparation. However, two recent cases of severe accidental burn illustrate the importance of precautions when using such products.