Suchergebnisse

Based on a foreign body immune reaction, the induced membrane technique (IMT) has become the preferred method for critical bone defect reconstruction in extremities. The present work is a synthesis of the clinical and experimental research that we have conducted with the objective of improving the outcomes of this procedure. First, we analyze the IMT application in our daily military practice and with low resources, before proposing a classification scheme of its failures that may be from septic, mechanical, or biological origin. Next, we present the development stages of a rat femoral defect model reproducing and studying the two steps of the technique, namely the encapsulation membrane formation then the bone repair itself. With this unique animal model, we have evaluated innovative materials to extend IMT use to precarious settings and to enhance membrane osteogenic properties. Considering our findings, we ultimately propose new research perspectives using that same model ; Basée sur une réaction immunitaire à corps étranger, la technique de la membrane induite (TMI) est devenue le mode de reconstruction privilégié des pertes de substance osseuses critiques des membres. Ce travail réalise une synthèse des recherches cliniques et expérimentales que nous avons menées dans le but d'améliorer les résultats obtenus avec ce procédé. Nous analysons d'abord l'application de la TMI dans notre pratique militaire quotidienne, puis en contexte sanitaire dégradé, avant de proposer une classification de ses échecs qui peuvent être d'origine septique, mécanique, ou biologique. Nous présentons ensuite les étapes du développement d'un modèle rongeur de défect fémoral visant à reproduire et étudier les deux temps de la technique ; à savoir la formation de la membrane d'encapsulation, puis la réparation osseuse elle-même. En utilisant ce modèle animal original, nous avons évalué des matériaux innovants pour étendre l'utilisation de la TMI en situation précaire et améliorer les propriétés ostéogéniques de la membrane. Enfin, à la lumière de nos résultats, nous proposons de nouvelles perspectives de recherche basées sur ce même modèle

Based on a foreign body immune reaction, the induced membrane technique (IMT) has become the preferred method for critical bone defect reconstruction in extremities. The present work is a synthesis of the clinical and experimental research that we have conducted with the objective of improving the outcomes of this procedure. First, we analyze the IMT application in our daily military practice and with low resources, before proposing a classification scheme of its failures that may be from septic, mechanical, or biological origin. Next, we present the development stages of a rat femoral defect model reproducing and studying the two steps of the technique, namely the encapsulation membrane formation then the bone repair itself. With this unique animal model, we have evaluated innovative materials to extend IMT use to precarious settings and to enhance membrane osteogenic properties. Considering our findings, we ultimately propose new research perspectives using that same model ; Basée sur une réaction immunitaire à corps étranger, la technique de la membrane induite (TMI) est devenue le mode de reconstruction privilégié des pertes de substance osseuses critiques des membres. Ce travail réalise une synthèse des recherches cliniques et expérimentales que nous avons menées dans le but d'améliorer les résultats obtenus avec ce procédé. Nous analysons d'abord l'application de la TMI dans notre pratique militaire quotidienne, puis en contexte sanitaire dégradé, avant de proposer une classification de ses échecs qui peuvent être d'origine septique, mécanique, ou biologique. Nous présentons ensuite les étapes du développement d'un modèle rongeur de défect fémoral visant à reproduire et étudier les deux temps de la technique ; à savoir la formation de la membrane d'encapsulation, puis la réparation osseuse elle-même. En utilisant ce modèle animal original, nous avons évalué des matériaux innovants pour étendre l'utilisation de la TMI en situation précaire et améliorer les propriétés ostéogéniques de la membrane. Enfin, à la lumière de nos résultats, nous proposons de nouvelles perspectives de recherche basées sur ce même modèle

Based on a foreign body immune reaction, the induced membrane technique (IMT) has become the preferred method for critical bone defect reconstruction in extremities. The present work is a synthesis of the clinical and experimental research that we have conducted with the objective of improving the outcomes of this procedure. First, we analyze the IMT application in our daily military practice and with low resources, before proposing a classification scheme of its failures that may be from septic, mechanical, or biological origin. Next, we present the development stages of a rat femoral defect model reproducing and studying the two steps of the technique, namely the encapsulation membrane formation then the bone repair itself. With this unique animal model, we have evaluated innovative materials to extend IMT use to precarious settings and to enhance membrane osteogenic properties. Considering our findings, we ultimately propose new research perspectives using that same model ; Basée sur une réaction immunitaire à corps étranger, la technique de la membrane induite (TMI) est devenue le mode de reconstruction privilégié des pertes de substance osseuses critiques des membres. Ce travail réalise une synthèse des recherches cliniques et expérimentales que nous avons menées dans le but d'améliorer les résultats obtenus avec ce procédé. Nous analysons d'abord l'application de la TMI dans notre pratique militaire quotidienne, puis en contexte sanitaire dégradé, avant de proposer une classification de ses échecs qui peuvent être d'origine septique, mécanique, ou biologique. Nous présentons ensuite les étapes du développement d'un modèle rongeur de défect fémoral visant à reproduire et étudier les deux temps de la technique ; à savoir la formation de la membrane d'encapsulation, puis la réparation osseuse elle-même. En utilisant ce modèle animal original, nous avons évalué des matériaux innovants pour étendre l'utilisation de la TMI en situation précaire et améliorer les propriétés ostéogéniques de la membrane. Enfin, à ...

BACKGROUND: In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. METHODS: A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). RESULTS: Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. CONCLUSIONS: Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. TRIAL REGISTRATION: Retrospectively registered on January 2019 (n°2019-090 1-001).

BACKGROUND: In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. METHODS: A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). RESULTS: Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. CONCLUSIONS: Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. TRIAL REGISTRATION: Retrospectively registered on January 2019 (n°2019-090 1-001).

BACKGROUND: In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. METHODS: A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). RESULTS: Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. CONCLUSIONS: Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. TRIAL REGISTRATION: Retrospectively registered on January 2019 (n°2019-090 1-001).

BACKGROUND: In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. METHODS: A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). RESULTS: Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. CONCLUSIONS: Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. TRIAL REGISTRATION: Retrospectively registered on January 2019 (n°2019–090 1-001).

BACKGROUND: In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. METHODS: A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). RESULTS: Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. CONCLUSIONS: Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. TRIAL REGISTRATION: Retrospectively registered on January 2019 (n°2019-090 1-001).