[Psychological impact of lockdown and the COVID-19 epidemic on haemodialysis patients and carers in France].

Introduction: The health crisis linked to the COVID-19 epidemic has required lockdown measures in France and changes in practices in dialysis centers. The objective was to assess the depressive and anxiety symptoms during lockdown in hemodialysis patients and their caregivers.

Methods: We sent, during lockdown period, between April and May 2020, self-questionnaires to voluntary subjects (patients and caregivers), treated by hemodialysis or who worked in hemodialysis in one of the 14 participating centers in France.

[Clarifying the definition of bullying].

Introduction: Bullying is a much discussed and studied concept and yet there is a huge amount of terms and definitions that describe it. The lack of unity and precision around bullying raises several questions, notably in the judicial field. Indeed, how can judges determine if a given situation comes close to bullying or not if they do not have a precise definition of what bullying consists in? The French law attempts to clarify this concept, but it still remains vague on several points, highlighting the effects of bullying without explaining its causes and nature.

Intraoperative mapping of sensate flaps. Electrophysiologic techniques and neurosomal boundaries.

Background: The desirability of restoring sensation to the upper aerodigestive tract has led to an expanded use of sensate flaps for reconstruction of mucosal defects. Sensation can be restored via preformed neural pathways through the anastomosis of recipient and donor nerves, provided that the sensate flap falls within the boundaries of the neurosome for the identified sensory nerve.

Objectives: To perform detailed electrophysiologic mappings of neurosomes of potential sensate flap donor sites, to describe their variability, and to investigate the usefulness of intraoperative mapping in terms of flap design and harvesting.

Continuous tissue oxygen tension measurement as a monitor of free-flap viability.

Early recognition of vascular compromise within microvascular free-tissue transfers is essential if reexploration is to prove successful. Tissue oxygen tension is increasingly recognized to be a sensitive and reliable index of tissue perfusion, and preliminary studies suggest that it may be of value in the assessment of free-flap viability. We describe our investigation into the application of an implantable microcatheter oxygen sensor in the monitoring of free flaps used in head and neck and extremity reconstruction.

Periadventitial delivery of heparin in the prevention of microvenous thrombosis.

Purpose: In spite of advances in technique and instrumentation, microvascular free tissue transfer remains associated with a persistent risk of flap failure. The use of systemic anticoagulants to overcome the formation of vasoocclusive thrombi at reactive anastomotic sites is associated with a high rate of flap hematoma and is ill advised in the operative setting. The purpose of this study was to investigate the use of a biodegradable, nontoxic polymer gel (polyvinyl alcohol, PVA) to effect a sustained localized release of perivascular heparin around thrombogenic venous anastomoses.

Reappraisal of the inferior epigastric flap: a new neurovascular flap model in the rat.

An anatomic, histologic, and electrophysiologic study was carried out in order to determine the distribution and cutaneous sensory territory of the epigastric nerve in the rat. Results for nerve staining (Sihler's method) and electrophysiologic nerve mapping indicate that the neurosome of the epigastric nerve has a different autonomy than the vascular territory of the inferior epigastric artery. Based on these findings, an experimental model for neurovascular free-tissue transfer is proposed.

Increased patency of artificial microvascular grafts using arteriovenous fistula loops: a two-stage procedure for lengthening the pedicle of free-tissue transfer.

The effect of a high-flow system on the patency of artificial microvascular grafts (AMG) was investigated using arteriovenous (A-V) fistula loops made of polytetrafluoroethylene (PTFE) in a clinically useful longer length. At a second stage, the A-V loops, matured for 7 days, were used as recipient conduits for free-tissue transfer. The patency rates of 5-cm long PTFE A-V fistula loops were compared with 5-cm and 1-cm long interpositional micrografts in a rat model.

Thrombolysis at a controlled pressure prolongs the survival of skin flaps treated with superoxide dismutase.

The role of thrombolysis in reestablishing patency in the microcirculation following ischemia, and thereby improving the efficacy of agents attenuating reperfusion injury, such as the oxygen free radical scavenger, superoxide dismutase (SOD), was investigated in a rat model. Abdominal skin flaps were subjected to normothermic ischemia induced by complete occlusion of the pedicle for periods of 12, 13, 14, 16, 18, 20, 22, and 24 hr. In Group 1 (n = 64), all animals received flap washout using 100,000U urokinase (manual injection) followed by 7,500 IU SOD given intra-arterially immediately prior to reperfusion.

Accidents with horses: what has changed in 20 years?

Horse riding is a dangerous pastime with more accidents occurring per hour than during motor-cycling. Since a prospective survey of horse-related injuries conducted at a major centre in 1971-1972, equestrian groups and the medical profession have encouraged improvements in training and protective riding wear. By conducting a similar study at the same centre 20 years later we hoped to assess the effects of these measures on the pattern of injuries resulting from contact with horses.

Additional benefit of heparin in the thrombolytic salvage of ischemic skin flaps.

Microvascular thrombosis is known to play an important part in the cessation of flow seen in a flap following ischemia and revascularization. Its reversal, using thrombolytic therapy, is associated with higher rates of successful flap salvage. Although this procedure restores patency to the microcirculation, the damaged endothelial cell layer remains highly thrombogenic and a definite risk of rethrombosis exists in the early period of reperfusion.

A standardized model of microvenous thrombosis.

A standardized model of venous thrombosis is necessary when evaluating potential antithrombotic or thrombolytic agents in microsurgery. Previous studies have shown the adventitial "tuck" model to be advantageous in terms of the vascular reactivity achieved and the relative ease of performance. However, variability exists in the current design, due to the lack of standardized dimensions of the adventitial flap.

Compression of the common peroneal nerve by a cyst of the lateral meniscus. A case report.

Ganglion cysts that compress the common peroneal nerve frequently arise from the proximal tibiofibular joint. In a 60-year-old man, the nerve was compressed by a cyst that arose from the lateral meniscus and extended around the posterolateral aspect of the fibular neck. The origin and extent of the lesion, which could not be determined by clinical examination, was seen through magnetic resonance imaging.

Use of the guinea pig flank flap in skin flap research.

A variety of flaps in laboratory animals have been designed that propose to parallel the behavior of human skin under different experimental conditions. In the search for a readily available and affordable island skin flap model that combines reliable anatomy with a pedicle of substantial size, we have designed in the guinea pig a cutaneous flap based on the superficial circumflex iliac artery and vein. In 22 adult female Hartley guinea pigs, an 8 x 4 cm flank flap based on the superficial circumflex iliac pedicle was raised, and its characteristics were evaluated for applications to skin flap research.

Improved efficacy of urokinase further prolongs ischemic skin-flap survival.

Salvage of a free-tissue transfer, when postoperative vascular compromise is detected, depends largely upon the restoration of a patent microcirculation. The therapeutic efficacy of thrombolytics infused directly into the failing flap has been clearly demonstrated. In this experiment, the authors investigated whether the method of selective administration of urokinase to failing skin flaps in 68 Sprague-Dawley rats had any effect on flap survival.

Glutathione disulphide as a marker of reperfusion injury in ischaemic skin flaps.

Estimation of the oxidised form of glutathione (GSSG) in an ischaemic/reperfused organ is frequently employed as an indicator of oxidative stress created by the production of oxygen free radicals during the reperfusion period. The time course of oxidative stress and tissue damage in 19 ischaemic/reperfused guinea-pig island skin flaps was evaluated. No-flow ischaemia was induced in the flaps for 6 h in 7 animals, and for 8 h in 9 animals (a further 3 animals served as controls without ischaemia).

Free flap monitoring: a review of current practice.

Individual techniques for the postoperative monitoring of free flaps vary considerably. In order to establish the currently preferred protocols, a survey was conducted among micro-surgeons in North America using a mailed questionnaire. Data were received from 95 centers for the monitoring of 2,825 free flaps performed during 1994.

[Esthetic and functional rehabilitation in a young irradiated patient].

The authors present the prosthetic rehabilitation of a young patient nineteen years old, radiated at four years old, during the treatment of right nasal fossa malignant tumour. Only metallic mandibular and maxillary dentals coverage can be considered after the realization of temporary supra-dental resin removable dentures, testing the possibilities of treatment, on esthetic and functional points of view.