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INTRODUCTION: Multiple surgical revisions (exeresis and directed healing) of recurrent pilonidal cysts are sources of unstable scars. Chronic ulcerations often appear with or without authentic recidivism. A local fasciocutaneous perforating flap based on the parasacral arteries would bring healthy tissue and avoid the disadvantages of conventional techniques (musculo-cutaneous or random). MATERIALS AND METHODS: A series of 8 cases of transposition flap covering based on parasacral perforators, in multi-operated patients. The perforators are identified by Doppler probe before the gesture, then the flap is traced obliquely according to the size of the loss of substance. The gesture is short, not morbid and accessible to all by a technique that excludes fine dissection of the pedicle. The duration of hospitalization is 2days. RESULTS: Despite two minor and resolving complications (a hematoma and a disunion of the donor sit) the healing was complete and without recurrence in all patients at 2years, with 100% satisfaction. CONCLUSION: This reliable and reproducible simple flap becomes the reference technique in our department for the sequelae of recurrent sacro-coccygeal cyst.
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Recurrencia Local de Neoplasia , Seno Pilonidal , Humanos , Microcirugia , Seno Pilonidal/cirugía , Trasplante de Piel , Colgajos QuirúrgicosRESUMEN
The authors report their experience with the use of Integra® dermal substitute, in combination with a thin skin graft, following an orbital exenteration. The clinical case described relates to a 42-year-old gentleman with an ulcerative retractile lesion of the right lower eyelid. Histopathological examination diagnosed a moderately differentiated epidermoid carcinoma infiltrating the orbit. Total exenteration was necessary as well as secondary radiation therapy and chemotherapy. Rehabilitation of the exenterated socket was performed by inserting an Integra® patch, followed by an additional thin skin graft one month later. The authors review the various available techniques for exenterations, their indications and the various possible secondary rehabilitations. Despite being less utilized, the dermal substitute technique, which is relatively new, seems to offer quicker and easier rehabilitation compared to traditional techniques. A comparative study would be necessary to define superiority among the different techniques of exenteration, with respect to the speed of rehabilitation and resistance to radiation therapy.
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Carcinoma de Células Escamosas/cirugía , Evisceración Orbitaria/métodos , Neoplasias Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel , Piel Artificial , Adulto , Carcinoma de Células Escamosas/patología , Neoplasias del Ojo/cirugía , Párpados/cirugía , Humanos , Masculino , Órbita/cirugía , Colgajos QuirúrgicosRESUMEN
INTRODUCTION: Bacterial necrotizing dermis-hypodermitis and necrotizing fasciitis (BNDH-NF) are serious life-threatening soft-tissue infections. The object is to evaluate the quality of life (QOL) of patients who have been operated in our plastic surgery departement. PATIENTS AND METHODS: This is a retrospective study of cases who have been treated at Nancy University Hospital between 2005 and 2014. We analyzed the perioperative data (demographic, clinical, bacteriological), the surgical data (excision, reconstruction) and the follow up data (consequences, mortality). The quality of life was assessed by the Short-Form 36 score, and the patients' satisfaction was assessed by a four-level scale. RESULTS: We analyzed 23 patients with an average age of 60 years (28-84 years). The main comorbidities were diabetes (43 %) and obesity (39 %). The average number of surgical excision was about 1.9 (1-5) and the average excised body surface area was about 5 % (1-16 %). The short-term mortality was about 17 %. The mortality rate has been statistically correlated with the surgically excised body surface area (short-term 95 days: P=0.02; and long-term: P=0.003). The statistical analysis has shown a strong relative linear relationship between number of surgical excision and the physical score of QOL (P<0.001), between number of surgical excision and mental score of QOL (P=0.032), and between age and physical score of QOL (P≤0.021). The statistical analysis has also shown a strong relative linear relationship between E. coli infections and physical score of QOL (P=0.01). The percentage of patients' satisfaction in our study was evaluated at 86 %. CONCLUSION: We have found that multiple surgical excisions, an advanced age of patients and E. coli infections have been associated with poor QOL. The mortality rate increased in relation with the importance of excised body surface. In spite of the gravity of these infections, our patients were satisfied of their treatment.
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Antibacterianos/uso terapéutico , Desbridamiento , Infecciones por Escherichia coli/complicaciones , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/terapia , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Desbridamiento/métodos , Dermis/patología , Complicaciones de la Diabetes/mortalidad , Fascitis Necrotizante/mortalidad , Fascitis Necrotizante/patología , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Mass spectrometric techniques were used to obtain detailed insight into the reactions of peroxyl radicals with model systems of (damaged) polyesters. Using a distonic radical ion approach, it was shown that N-methylpyridinium peroxyl radical cations, Pyr(+)OOË, do not react with non-activated C-H bonds typically present in polyesters that resist degradation. Structural damage in the polymer, for example small amounts of alkene moieties formed during the manufacturing process, is required to enable reaction with Pyr(+)OOË, which proceeds with high preference through addition to the π system rather than via allylic hydrogen atom abstraction (kadd/kHAT > 20 for internal alkenes). This is due to the very fast and strongly exothermic subsequent fragmentation of the peroxyl-alkene radical adduct to epoxides and highly reactive Pyr(+)OË, which both could promote further degradation of the polymer through non-radical and radical pathways. This work provides essential experimental support that the basic autoxidation mechanism is a too simplistic model to rationalize radical mediated degradation of polymers under ambient conditions.
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Espectrometría de Masas/métodos , Peróxidos/química , Poliésteres/química , Cationes/química , Radicales Libres/química , Cinética , Compuestos de Piridinio/químicaRESUMEN
UNLABELLED: Buttock enhancement using gluteal silicone implants is known as a high risk of complications procedure. However, few studies have attempted to quantify the rate of overall complications. The aim of this work is to analyze the rates and types of complications encountered by French plastic surgeons practicing this procedure, and to review their technical choices about incisional access, implant plane, implant type, postoperative instructions, and drain use. We also tried to assess patients global satisfaction rate. MATERIAL AND METHODS: A survey of 17 questions was emailed to French Plastic Surgeons (sent through the channel tamtam@plasticiens.com and emails), the criterias studied included information about number of cases performed, surgical approach used, implant placement plane and implant type, drainage, postoperative instructions, complications experienced and patients satisfaction. RESULTS: Thirteen participants provided data on 538 patients, 84.6% of surgeons used a single incision, 100% favored the intramuscular dissection plane over the subfascial plane, 38% have experienced complications (all types included). The main complications encountered were wound separation (4,4%), seroma (2.2%), infections requiring explantation (1.4%), caspular retraction (1.3%) and asymmetry (3.3%). The global patients satisfaction rate was 8/10. CONCLUSION: Our results show that this procedure remains reliable, and serious complications are rare. It also helps providing an assessment of French plastic surgeons practices with the aim of popularizing this procedure.
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Nalgas/cirugía , Procedimientos de Cirugía Plástica , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prótesis e Implantes , Geles de Silicona , Femenino , Francia , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Prótesis e Implantes/efectos adversos , Encuestas y CuestionariosRESUMEN
Aromatic radicals form in a variety of reacting gas-phase systems, where their molecular weight growth reactions with unsaturated hydrocarbons are of considerable importance. We have investigated the ion-molecule reaction of the aromatic distonic N-methyl-pyridinium-4-yl (NMP) radical cation with 2-butyne (CH(3)C≡CCH(3)) using ion trap mass spectrometry. Comparison is made to high-level ab initio energy surfaces for the reaction of NMP and for the neutral phenyl radical system. The NMP radical cation reacts rapidly with 2-butyne at ambient temperature, due to the apparent absence of any barrier. The activated vinyl radical adduct predominantly dissociates via loss of a H atom, with lesser amounts of CH(3) loss. High-resolution Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometry allows us to identify small quantities of the collisionally deactivated reaction adduct. Statistical reaction rate theory calculations (master equation/RRKM theory) on the NMP+2-butyne system support our experimental findings, and indicate a mechanism that predominantly involves an allylic resonance-stabilized radical formed via H atom shuttling between the aromatic ring and the C(4) side-chain, followed by cyclization and/or low-energy H atom ß-scission reactions. A similar mechanism is demonstrated for the neutral phenyl radical (PhË)+2-butyne reaction, forming products that include 3-methylindene. The collisionally deactivated reaction adduct is predicted to be quenched in the form of a resonance-stabilized methylphenylallyl radical. Experiments using a 2,5-dichloro substituted methyl-pyridiniumyl radical cation revealed that in this case CH(3) loss from the 2-butyne adduct is favoured over H atom loss, verifying the key role of ortho H atoms, and the shuttling mechanism, in the reactions of aromatic radicals with alkynes. As well as being useful phenyl radical analogues, pyridiniumyl radical cations may form in the ionosphere of Titan, where they could undergo rapid molecular weight growth reactions to yield polycyclic aromatic nitrogen hydrocarbons (PANHs).