Impact of surgical first excision delay on function for heat-press hand injury by the Quick-DASH questionnaire: Series over 20 years.

BACKGROUND: Heat-press hand burn leads to complex and severe lesions, with potentiation of thermal burn by the crushing mechanism. Management remains poorly codified, and the surgical strategies found in the literature remain contradictory. The objective of our study is to report our experience and define the first burn excision delay through functional evaluation with a Quick-DASH questionnaire. METHODS: We carried out a retrospective study of 20 burned hands by heat-press managed in our burn unit between 2002 and 2021. Following data were collected, at least one year after the accident: Quick-DASH score, which was our primary endpoint, injury assessment according to the Tajima's classification, overall surgical management, and impact on their professional activity. A descriptive statistical analysis of these data was performed followed by a univariate analysis to assess the correlation between delay to first surgical excision and the long-term functional result (Quick-DASH score and time before return to work). RESULTS: Burns were Tajima grade 1 (supra-fascial dermal burn) in 35 % of cases, grade 2 (exposure of subfascial structures) in 45 % and grade 3 (bone or joint exposure) in 20 %. There were no cases of bone fractures. We received 18 out of 20 questionnaires with no significant differences between those who send back or not. The median QuickDash score was 7.15 [IQR 0-52.25]. The first surgical excision was performed with a median of 8 days after the accident [min: 0; max: 20]. The median time before return to work was 24 weeks [IQR 17-42.25]. Only 11 patients (55 %) were able to go on the initial employment. Spearman test found a strong trend for a negative correlation between the time to the first excision and the QuickDash score (ρ = -0.46; r2 = 0.087; p = 0.053). CONCLUSION: According to observations made in our unit and in agreement with Tajima, who first described heat-press injury, the first surgical excision should be performed approximately one week after the accident. Subsequent excisions may be performed to reassess the lesions and complete the debridement, with reconstruction to follow. Multidisciplinary management is still necessary, including early and intensive physiotherapy, psychological support, and assessment by an occupational physician.

["Junior Doctor" in Plastic Surgery, a new status. Evaluation of the practices after one semester of application of the reform]. / Docteur Junior en chirurgie plastique, un nouveau statut. Évaluation des pratiques après un semestre d'application de la réforme.

INTRODUCTION: The reform of the third cycle of medical studies in 2017 led to the creation of the status of "Junior Doctor", corresponding to the consolidation phase and allowing increasing autonomy and supervision from the intern. In plastic surgery, this status appeared for the first time in November 2021 in French hospitals; it lasts two years and succeeds the first four years of internship. MATERIAL AND METHODS: We sent a self-questionnaire by email in May 2022 to the 21 French Junior Doctors. This was interested in their training ground, formation program, consultation activity, operating program, integration into the on-call list, the existence of half-days of availability, and their general opinion on this reform and its implementation. RESULTS: We collected 20 questionnaires with a sex ratio of twelve men for eight women. The majority of respondents worked in a university hospital (85 %). 45 % had their consultations, 60 % had their own operating sessions under general anesthesia, and 35 % under local anesthesia. Only 25 % of them considered this reform to be a step forward in terms of training. CONCLUSION: The introduction of the status of Junior Doctor is contrasted within the various hospitals. Despite the progressive and supervised autonomy provided by this reform, it is generally perceived neutrally or negatively by Junior Doctors. The establishment of own consultations and operating sessions stands out as a key positive element allowing better application of the reform.

[The de-epidermized sural flap: An original technique to increase the reliability of the neurocutaneous sural flap]. / Le lambeau sural désépidermisé : technique originale de fiabilisation du lambeau neurocutané sural.

BACKGROUND: The neurocutaneous sural flap is useful to cover defects of the distal quarter of the lower limb. Nevertheless, severe complications occur in 14% of the cases, and venous congestion is reported in 75% of these cases. This congestion can lead to total necrosis of the flap and a failure of the procedure. We describe a new surgical method aiming to reduce the risk of venous congestion occurrence and failure of the defect coverage. PATIENTS AND METHODS: We realized a retrospective study of patients who undergone a de-epidermized distally based neurocutaneous sural flap in our surgery department from 2015 to 2020. The following data were collected: sex, age, vascular risk factors, size of the wound, defect area, etiology, delay between the surgery of the flap and the split-thickness skin graft and complications. RESULTS: The cohort is composed of 5 cases. We reported no failure of the coverage of the defect. There were no cases of venous congestion. CONCLUSION: The de-epidermized distally based neurocutaneous sural flap could increase the reliability of these flaps by reducing the risk of venous congestion. A larger study comparing the classic technique to the de-epidermized sural flap could confirm these data on a greater number of cases and position this technique in the therapeutic arsenal.