Objective To evaluate a structured pharmacist-led implant education service six months after surgery. Methods POSTIMP was a multicentre, participant-blinded randomised controlled trial in orthopaedic and plastic surgery centres within a French university hospital. Adults undergoing hip, knee, or breast implantation were randomised 1:1 to usual support (15-min consultation with implant documents, booklet presentation, and questions) or structured support (30-min interactive consultation adding a six-question quiz, implant image, corrective feedback, and counselling on identification, traceability, follow-up, vigilance, and adverse-event reporting). The primary outcome was correct spontaneous recall of the implant manufacturer, brand, or model at six months, verified against hospital traceability records. Intention-to-treat analyses used logistic regression. Results Among 235 participants, spontaneous recall was higher with structured than usual support (13.6% vs 1.7%; odds ratio [OR] 9.02, 95% confidence interval [CI] 2.49–57.9; p = 0.004). In an exploratory imputed analysis, correct identification from memory or a predefined list was also higher (29.7% vs 12.8%; OR 2.87, 95% CI 1.49–5.75; p = 0.002). Awareness of adverse-event self-reporting increased (OR 2.46, 95% CI 1.40–4.40; p = 0.002), and more participants contacted the surgical department (OR 3.12, 95% CI 1.38–7.77; p = 0.009), without more emergency visits or hospitalisations. Conclusion Structured pharmacist-led implant education improved verified implant knowledge and direct postoperative engagement. It may support earlier, better-directed responses to implant-related concerns, although effects on complications and healthcare use require confirmation.Trial registration: NCT04302233.

Various methods such as elastography or mechanical testing have been developed to quantify the mechanical properties of soft tissues, which are related to the tissue local pathophysiological conditions. This study is the first one to investigate the in vivo performances of the Impact-Based Analysis Method (IBAM) to characterize the biomechanical behavior of skin during physiological mechanisms. A murine model (12 Sprague-Dawley rats) was considered and various measurements of skin mechanical properties were conducted on different regions of interest over a 3-week period. The effects of wound healing after full-thickness excisional wound and an intradermal hyaluronic acid (HA) injection were monitored using IBAM, as well as two commercially available devices: Cutometer® and MyotonPro®. The indicators Δt (from IBAM), R0 and R5 (from Cutometer®) vary significantly as a function of wound healing time, which corresponds to a stiffening of healing tissue compared to healthy tissue. The indicator Δt and S (from MyotonPro®) are significantly different when HA was injected compared to healthy tissue, which also corresponds to less stiff tissue. Additionally, both IBAM and Cutometer® detect significant biomechanical variations in superficial soft tissue related to tissue growth in all measurement regions. This first in vivo use of IBAM shows that IBAM could assess significant variations related to wound healing or regeneration mechanisms following HA injection. This study paves the way for the development of a simple, low-cost and objective device. Future clinical studies or other animal models should be carried out to confirm these results.

Assessing the biomechanical properties of soft tissues can be useful because they are related to their pathophysiological state. This study explores the application of artificial intelligence (AI) to an Impact-Based Analysis Method (IBAM) to predict the mechanical properties of soft tissues. 40 agar-based soft tissue phantoms with different stiffness were prepared. For each phantom, Young’s modulus was estimated using dynamic mechanical analysis and IBAM measurements were performed. Various AI-based models were applied to the results obtained with the IBAM approach to predict Young’s modulus. Principal component analysis shows that three parameters can explain 85% of the variation in IBAM data. The times of the different maxima of the force signal peaks are significantly correlated with Young’s modulus (R2 = 0.99). Most AI-based models allow a decrease in the prediction error compared to the standard IBAM approach (from 5.4% down to 1.2%). Decision trees and ensemble stacking, as well as convolutional neural networks, show a decrease in the prediction error of 74% and 50%, respectively. Applying AI approaches within the IBAM framework is a powerful approach to identify Young’s modulus of soft tissues. This study paves the way for using AI-based methods to characterize superficial soft tissue biomechanical properties.

Patients undergoing breast reconstruction with the DIEP flap are at risk of arterial and venous thrombosis, necessitating flap salvage surgery. However, this carries the risk of ischemia- reperfusion injury (IRI) and potential significant partial, or complete flap loss. The objective of this study was to evaluate the potential benefit of corticosteroids in reducing IRI related complications in DIEP flaps that are returned to theatre for attempted salvage after venous or arterial failure.A double-blinded prospective randomized study was conducted between January 2012 and January 2023 on patients scheduled for secondary unilateral breast reconstruction using the DIEP flap technique. Patients were included if they developed postoperative venous or arterial flap thrombosis and experienced DIEP flap IRI following operative take-back and anastomosis revision.The treatment group (TG) received a 5-day course of corticosteroids, while the control group (CG) did not receive any specific treatment. Forty-six patients were enrolled in the study. In the CG, two cases of total flap loss and eight cases of partial flap necrosis were observed, while the TG had only one case of partial flap necrosis (p< 0.05). The complete resolution of clinical signs of IRI occurred within 13±2.1 days for the TG and 21±3.5 days for the CG (p=0.00001). The TG had a significantly shorter hospital stay (11.13±0.38 days) compared to the CG (15.47±1.27 days), p<0.0001. Targeted corticosteroid therapy following a salvage procedure for vascular thrombosis in DIEP flaps has shown promise as an effective treatment for subsequent IRI. This approach may be considered as a viable option for managing IRI in free flaps. However, further studies involving a larger number of patients are required to substantiate our hypothesis.

The authors would like to add an affiliation to their paper. "I, Dr.Dana Sawan, would like to add an affiliation to my published paper: Augmented reality-assisted deep inferior epigastric artery perforator flap harvesting. Published on 22 April 2021."

Adjuvant radiotherapy for breast cancer may involve some incidental exposure of the ipsilateral internal mammary artery to ionizing radiation. However, the relevant evidence is limited and inconsistent. The dataset presented in this article contains the information used to assess the effects of accidental radiation exposure on the internal mammary artery in patients with unilateral total mastectomy followed radiotherapy for breast cancer. The study population consists of two groups: the irradiated group and the control group. The left and right internal mammary arteries were assessed through the second intercostal spaces using a computed sonography system (Vivid S6; GE, Tirat Carmel, Israel) equipped with a 5.5 - 11 MHz transducer. The recorded parameters were the diameter, time-averaged maximum velocity, and blood flow of the internal mammary artery.The dataset contains two files of data: a raw and an analyzed data. The raw data file contains the individual information of each participant, including demographic characteristics and the parameters of the internal mammary artery duplex ultrasound imaging. The analyzed data file was made up of R Markdown, a markup language of R. The results of data analysis were presented in the related research article which has been accepted for publication in the Annals of Vascular Surgery. The dataset presented in this article may be reused for further studies in which the internal mammary artery is considered as potential donor or recipient vessels for a vascular bypass or free flap anastomosis.

The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, necrotising soft-tissue infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect necrotising soft-tissue infections, fuelled by poor awareness of the disease, promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This Review will focus on practical approaches to management of necrotising soft-tissue infections including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for these infections should improve time to diagnosis and early referral to specialised centres, with improvement in the prognosis of necrotising soft-tissue infections.

Our center is considered expert for DIEP reconstructions since its development in end of the nineties. Our data showed no impact PMRT using conventional fractionation (with mainly 1.8 Gy/fraction) on cosmetic results, QoL, and patients' satisfaction regardless of the timing of the breast reconstruction. Additional studies are in progress with updates.

Journal of the European Academy of Dermatology and VenereologyVolume 37, Issue 4 p. e463-e465 LETTER TO THE EDITOR Abdominoperineal necrotizing soft tissue infection: A single-centre retrospective study of 61 patients including short- and medium-term source of infection check Margaux Mongereau, Corresponding Author Margaux Mongereau [email protected] orcid.org/0000-0001-8882-7501 Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France Correspondence Margaux Mongereau, Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, 1 avenue Gustave Eiffel, Créteil 94000, France. Email: [email protected]Search for more papers by this authorCamille Hua, Camille Hua Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorTomas Urbina, Tomas Urbina Department of Intensive Care, AP-HP, Hôpital Saint Antoine, Faculté de Santé, Université Sorbonne, Université Pierre-et-Marie Curie-Paris 6, Paris, FranceSearch for more papers by this authorPaul Louis Woerther, Paul Louis Woerther orcid.org/0000-0002-6957-9482 Department of Microbiology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorTiphaine Pelegrin, Tiphaine Pelegrin Department of Urology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorNicola de'Angelis, Nicola de'Angelis Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorQuentin De Roux, Quentin De Roux Department of Surgical Intensive Care Unit, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorRomain Bosc, Romain Bosc Department of Plastic Surgery, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorBarbara Hersant, Barbara Hersant Department of Plastic Surgery, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorNicolas de Prost, Nicolas de Prost Department of Intensive Care, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France Groupe de Recherche Clinique CARMAS, Université Paris-Est, Créteil, FranceSearch for more papers by this authorOlivier Chosidow, Olivier Chosidow orcid.org/0000-0002-8400-4310 Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, FranceSearch for more papers by this author Margaux Mongereau, Corresponding Author Margaux Mongereau [email protected] orcid.org/0000-0001-8882-7501 Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France Correspondence Margaux Mongereau, Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, 1 avenue Gustave Eiffel, Créteil 94000, France. Email: [email protected]Search for more papers by this authorCamille Hua, Camille Hua Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorTomas Urbina, Tomas Urbina Department of Intensive Care, AP-HP, Hôpital Saint Antoine, Faculté de Santé, Université Sorbonne, Université Pierre-et-Marie Curie-Paris 6, Paris, FranceSearch for more papers by this authorPaul Louis Woerther, Paul Louis Woerther orcid.org/0000-0002-6957-9482 Department of Microbiology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorTiphaine Pelegrin, Tiphaine Pelegrin Department of Urology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorNicola de'Angelis, Nicola de'Angelis Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorQuentin De Roux, Quentin De Roux Department of Surgical Intensive Care Unit, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorRomain Bosc, Romain Bosc Department of Plastic Surgery, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorBarbara Hersant, Barbara Hersant Department of Plastic Surgery, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, FranceSearch for more papers by this authorNicolas de Prost, Nicolas de Prost Department of Intensive Care, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France Groupe de Recherche Clinique CARMAS, Université Paris-Est, Créteil, FranceSearch for more papers by this authorOlivier Chosidow, Olivier Chosidow orcid.org/0000-0002-8400-4310 Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, FranceSearch for more papers by this author First published: 14 November 2022 https://doi.org/10.1111/jdv.18729 Margaux Mongereau, Camille Hua, Nicolas de Prost, and Olivier Chosidow equally contributed to the study. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1Sorensen MD, Krieger JN. Fournier's gangrene: epidemiology and outcomes in the general US population. Urol Int. 2016; 97(3): 249– 59. 2Sorensen MD, Krieger JN, Rivara FP, Broghammer JA, Klein MB, Mack CD, et al. Fournier's gangrene: population based epidemiology and outcomes. J Urol. 2009; 181(5): 2120– 6. 3Eke N. Fournier's gangrene: a review of 1726 cases. 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Necrotizing fasciitis of the thigh revealing a Crohn's disease. J Eur Acad Dermatol Venereol. 2015; 29(8): 1648– 9. 9Yoshino Y, Funahashi K, Okada R, Miura Y, Suzuki T, Koda T, et al. Severe Fournier's gangrene in a patient with rectal cancer: case report and literature review. World J Surg Oncol. 2016; 14(1): 234. 10Hua C, Urbina T, Bosc R, Parks T, Sriskandan S, de Prost N, et al. Necrotising soft-tissue infections. Lancet Infect Dis. 2022; 3099:S1473-3099(22)00583-7. Volume37, Issue4April 2023Pages e463-e465 ReferencesRelatedInformation

Face transplantation is a viable reconstructive approach for severe craniofacial defects. Despite the evolution witnessed in the field, ethical aspects, clinical and psychosocial implications, public perception, and economic sustainability remain the subject of debate and unanswered questions. Furthermore, poor data reporting and sharing, the absence of standardized metrics for outcome evaluation, and the lack of consensus definitions of success and failure have hampered the development of a "transplantation culture" on a global scale. We completed a 2-round online modified Delphi process with 35 international face transplant stakeholders, including surgeons, clinicians, psychologists, psychiatrists, ethicists, policymakers, and researchers, with a representation of 10 of the 19 face transplant teams that had already performed the procedure and 73% of face transplants. Themes addressed included patient assessment and selection, indications, social support networks, clinical framework, surgical considerations, data on patient progress and outcomes, definitions of success and failure, public image and perception, and financial sustainability. The presented recommendations are the product of a shared commitment of face transplant teams to foster the development of face transplantation and are aimed at providing a gold standard of practice and policy.

Background: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon peripheral T-cell lymphoma most frequently arising around a textured surface breast implant. It has been shown that capsule infiltration (T2, T3 and T4 of the TNM staging system) was an adverse prognostic factor. In this context, chemotherapy (with or without brentuximab vedotin [BV]) may be proposed, considering other factors such as metastatic disease or incomplete resection. Furthermore, the need for adjuvant chemotherapy in patients with stage IIA (T4N0M0) and complete en-bloc excision without residual disease is debated. Aim: To assess the management of BIA-ALCL with capsule infiltration, in particular: 1) To assess the impact of BV in those patients; 2) To evaluate the need for adjuvant chemotherapy in patients with stage IIA and complete en-bloc excision without residual disease. Methods: Since 2016, a national multidisciplinary meeting has been implemented by the French National Cancer Institute (NCI) to optimize management of patients with BIA-ALCL, particularly those with advanced disease. Meanwhile, a national registry has been set up by the LYSA, in collaboration with health authorities. Central pathological review has been carried out within the French NCI-labeled Lymphopath network. Results: From 2009 to 2023, 125 patients with BIA-ALCL were recorded, of which 111 (94 from France and 17 from Belgium) had complete data and were included in the present analysis. Overall, median age at diagnosis of BIA-ALCL was 58 years (24-82 years). Reasons for initial implantation were breast cancer reconstruction (n=54; 49%), cosmetic (n=45; 41%) or other (n=12; 10%). The median interval from first implantation to diagnosis of BIA-ALCL was 12.3 years (4-40 years). The median number of implants in the breast involved by BIA-ALCL was 2 (1-8), including at least one silicone implant in 95 (86%) patients, and at least one textured implant in all informative cases (n=102; Most often Allergan Biocell implants). At diagnosis of BIA-ALCL, 78/110 (71%) patients presented with periprosthetic effusion only, 20 (18%) had effusion and a breast mass, 6 (5.5%) had a breast mass only, and 6 (5.5%) had neither. At pathological examination of the capsule, T-stage was T1 (confined to effusion or a layer on luminal side of capsule) in 73/111 (66%) cases, T2-T3 (capsule infiltration) in 5 (4.5%) cases, T4 (lymphoma infiltrates beyond the capsule) in 32 (29%) cases, and unclassifiable in 1 case. Moreover, 18/111 (16%) patients had at least one non-breast extranodal involvement. Among the 36 patients with capsule infiltration (5 T2-T3 and 31 T4), 13 (including 11 T4) were treated with BV-CH(E)P regimen, 12 (all T4) with a CHOP/CHOP-like regimen, and 11 (including 8 T4) did not receive any chemotherapy. The main reasons for receiving chemotherapy were metastatic disease, incomplete resection, or no surgery. Patients who did not receive chemotherapy had a localized disease (3 stage IB/IC and 8 stage IIA) with complete en-bloc excision and no residual disease. Patients treated with BV-CH(E)P regimen and CHOP/CHOP-like regimen had similar characteristics without significant differences regarding age, clinical presentation, stage and surgery. After a median follow-up of 47 months from BIA-ALCL diagnosis, for BV-CH(E)P and CHOP/CHOP-like groups, the respective 4-year PFS rates were 100% and 57% (p=0.01), and the respective 4-year OS rates were 100% and 73% (p=0.07). Regarding the 11 patients who did not receive chemotherapy, 4-year PFS and OS were both 75%, which corresponds to a single event being a death without progression occurring more than 3 years after the diagnosis of lymphoma (4-year lymphoma-specific survival was 100%). Conclusions: 1) In patients with capsule infiltration requiring chemotherapy, BV-CH(E)P regimen was associated with improved PFS and OS compared with CHOP/CHOP-like regimen; 2) Patients with stage IIA and complete en-bloc excision without residual disease had favorable outcome without the need for adjuvant chemotherapy. These results should be confirmed prospectively.

BACKGROUND:Oncologic excision and trauma can be responsible for major defects and lymphedema. Free flaps are commonly used for reconstruction. We aimed to determine if lymphatic flow between flap and recipient site can be restored without lymphatic surgery.METHODS:15 free flaps were performed in different patients in our center. Infrared-based lymphography was used to plan surgery. Indocyanine green (ICG) was injected in the flap's subdermal tissue and also at the edges of the skin defect. Circumferential lymphatic channels were marked 5 min after the ICG injection. Fluorescent images were recorded with an infrared camera system. The flap inset was obtained by putting side to side the flap markings and the recipient site markings. Infrared-based lymphography was performed on every patient one year after surgery. Spontaneous lymph flow restoration was judged positive if lymphatic connections were observed between the flap and the recipient site.RESULTS:seven free ALT and eight DIEP flaps were performed. All ALT flaps were designed following the limb axis which is the lymphatic axiality. Spontaneous lymph flow restoration was observed for the seven ALT flaps. Eight DIEP flaps were designed upside down and one was designed following the lymph axiality. Spontaneous lymph flow restoration was only observed for the one designed following the lymph axiality.CONCLUSIONS:designing reconstructive free flap regarding lymph axiality seems to improve spontaneous lymph flow restoration between flap and recipient site without any specific lymphatic surgery.

Uterine transplantation is becoming an increasingly realistic therapeutic for uterine infertility. Surgical training on large animal models such as sheep is a prerequisite for establishing a program in humans. The objective of our study was to analyze the predictive factors for successful vascular anastomoses. We performed 40 autotransplants that involved end-to-side anastomoses from the uterine to the external iliac vessels. We analyzed vessel results in terms of success or failure; a total of 78.7% of arterial and 82.9% of venous anastomoses were successful in the immediate postoperative period. In multivariate analysis, independent factors associated with immediate successful vein anastomoses were as follows: a short warm ischemia time (<2 h, OR = 0.05; 95% CI [0.003–0.88], p = 0.04), the absence of any anastomotic complications (OR = 0.06; 95% CI [0.003–0.099], p = 0.049), and their realization by a vascular surgeon (OR = 29.3; 95% CI [1.17–731.9], p = 0.04). Secondly, we showed that an increase in lactate levels greater than 2.72 mmol/L, six hours after reperfusion was predictive of failure, with a sensibility of 85.7% and a specificity of 75.0%. In order to perfect the management of vascular anastomoses by a vascular surgeon, training on animal models and in microsurgery are mandatory in establishing a uterine transplantation program in humans.

BACKGROUND:The objective of breast reconstruction (BR) is to erase the after-effects of total mastectomy by allowing patients to restore their breast shape. The aim of our study was to investigate the body map integration of different types of BR using functional magnetic resonance (fMRI).PATIENTS AND METHODS:We prospectively enrolled all women undergoing BR for breast cancer to the Remasco study (NCT02553967). Participants were categorized into four groups according to the standard of care they required: immediate BR (IBR), delayed BR (DBR), flap (autologous), or implant BR. Each patient performed sensorimotor tasks during the fMRI acquisition.RESULTS:Data of 38 patients were analyzed. We identified the cingulate region as the area of interest in the brain. In the case of DBR, the brain area activated during palpation of the total mastectomy scar (before BR) was different from the brain area activated during palpation of the reconstructed breast (Brodmann areas 31 versus 32). Palpation of the native breast and reconstructed breast activated the same Brodmann area 32. Comparing the brain activation signal during palpation of the native breast and the reconstructed breast did not reveal any significant difference in the overall population (P = 0.41) or in the groups: autologous (P = 0.32), implant (P = 0.10), IBR (P = 0.72), or DBR (P = 0.10).CONCLUSIONS:This experimental study allowed us to describe and understand the brain plasticity processes that accompany BR. The results suggest that the reconstructed breast is integrated into the body schema, regardless of the type of BR or the timing.

Background: Osteotomies during rhinoplasty are usually based on surgeon's proprioception to determine the number, energy, and trajectory of impacts. Objective: The first objective was to detect the occurrence of fractures. The second objective was to determine when the thicker frontal bone was encountered by the osteotome. Materials and Methods: An instrumented hammer was used to measure the impact force during lateral osteotomies on nine human anatomic specimens. A prediction algorithm was developed using machine learning techniques, to detect the occurrence of fractures, and the proximity of the osteotome to the frontal bone. Results: The algorithm was able to predict the occurrence of fractures and the proximity to the frontal bone with a prediction rate of 83%, 91%, and 93% when allowing for an error of 0, 1, and 2 impacts, respectively. The location of the osteotome in the frontal bone was predicted with an error of 7.7%. Conclusion: An osteotomy hammer measuring the impact force when performing lateral osteotomies can predict the occurrence of fractures and the proximity to the frontal bone, providing the surgeon with instant feedback.

The first baby following a uterine transplantation carried out by a Swedish team was born in 2014. Since this success, approximately 80 uterine grafts were carried out throughout the world, mainly from alive donors, and 30 children were born in good health. The surgical technique of this recent intervention remains in construction. The objective of this study was to report a multidisciplinary experimental model of uterine transplantation involving the vascular surgeons.

Osteotomies during rhinoplasty are usually based on the surgeon's proprioception to determine the number and the strength of the impacts. The aim of this study is to determine whether a hammer instrumented with a force sensor can be used to classify fractures and to determine the location of the osteotome tip. Two lateral osteotomies were realized in nine anatomical subjects using an instrumented hammer recording the evolution of the impact force. Two indicators tau and lambda were derived from the signal, and video analysis was used to determine whether the osteotome tip was located in nasal or frontal bone as well as the condition of the bone tissue around the osteotome tip. A machine-learning algorithm was used to predict the condition of bone tissue after each impact. The algorithm was able to predict the condition of the bone after the impacts with an accuracy of 83%, 91%, and 93% when considering a tolerance of 0, 1, and 2 impacts, respectively. Moreover, in nasal bone, the values of tau and lambda were significantly lower (p < 10(-)(10)) and higher (p < 10(-4)) than in frontal bone, respectively. This study paves the way for the development of the instrumented hammer as a decision support system.

The 2007 Banff working classification of skin‐containing Tissue Allograft Pathology addressed only acute T cell–mediated rejection in skin. We report the longitudinal long‐term histological follow‐up of six face transplant recipients, focusing on chronic and mucosal rejection. We identified three patterns suggestive of chronic rejection (lichen planus‐like, vitiligo‐like and scleroderma‐like). Four patients presented lichen planus‐like and vitiligo‐like chronic rejection at 52 ± 17 months posttransplant with severe concomitant acute T cell–mediated rejection. After lichen planus‐like rejection, two patients developed scleroderma‐like alterations. Graft vasculopathy with C4d deposits and de novo DSA led to subsequent graft loss in one patient. Chronic active rejection was frequent and similar patterns were noted in mucosae. Concordance between 124 paired skin and mucosal biopsies acute rejection grades was low (κ = 0.2, p = .005) but most grade 0/I mucosal rejections were associated with grade 0/I skin rejections. We defined discordant (grade≥II mucosal rejection and grade 0/I skin rejection) (n = 55 [70%]) and concordant (grade≥II rejection in both biopsies) groups. Mucosal biopsies of the discordant group displayed lower intra‐epithelial GranzymeB/FoxP3 ratios suggesting a less aggressive phenotype (p = .08). The grading system for acute rejection in mucosa may require phenotyping. Whether discordant infiltrates reflect a latent allo‐immune reaction leading to chronic rejection remains an open question.

Breast reconstructive surgery with deep inferior epigastric artery perforator (DIEP) flaps is a microsurgical technique that requires the dissection of small perforating vessels through the rectus abdominis muscle and fascia 1 Koshima I. Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989; 42: 645:8 Abstract Full Text PDF PubMed Scopus (812) Google Scholar . The anatomical pathways of these vessels complicate the procedure 2 Ireton J.E. Lakhiani C. Saint-Cyr M. Vascular anatomy of the deep inferior epigastric artery perforator flap: a systematic review. Plast Reconstr Surg. 2014; 134: 810e:21e Crossref Scopus (31) Google Scholar and can increase the operative time. Complementary preoperative examinations 3 Smit J.M. Klein S. Werker P.M.N. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesthet Surg. 2010; 63: e674:82 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar are used to map the perforators and optimize the dissection time.