Coverage of clavicular area by a pectoralis minor pedicle flap: anatomical study and description of three clinical cases.

As the data in the literature concerning the vascularization of the pectoralis minor were conflicting, we conducted a new anatomic study on cadavers preliminary to clinical application of a pedicle flap for clavicular coverage in 3 patients. Twenty flaps were dissected, yielding numerous anatomic variations. In all cases, the principal arteries penetrated the muscle in its upper part, either posteriorly or posterolaterally.

Influence of glomerular filtration rate on the clearance of vancomycin administered by continuous infusion in burn patients.

The relationship between clearance of vancomycin administered by continuous infusion and the glomerular filtration rate (GFR) estimated by creatinine clearance (CL(Cr)) was investigated in a large cohort of burn patients. Individual vancomycin clearance (CL(Van)) was estimated from the ratio between the rate of infusion and the plasma concentration at steady state for 70 patients (149 samples). The average value of CL(Van) (7.

Suitable age for nasal reconstruction after subtotal amputation in a child, with respect to a case involving purpura fulminans.

The authors report a case of nasal reconstruction in a 5-year-old boy who had undergone subtotal amputation of the nose 8 months before in the context of meningococcus-induced purpura fulminans. Two-step surgery involved implantation of a forehead expansion graft preliminary to use of a contralateral forehead flap to cover a cartilaginous graft from the concha that reconstituted the ala nasi, columella, and septum. At 1 year of follow-up, the results were considered quite satisfactory esthetically and psychologically beneficial.

Salvaging limbs in cases of severe purpura fulminans: advantages of free flaps.

Background: Purpura fulminans remains a severe and potentially life-threatening disorder, despite advances in intensive care that have led to a significant increase in the survival rate. One major risk is amputation of extremities.

Methods: The present report concerns a series of four patients (all male; mean age, 19 years) whose lower limb extremities were salvaged by the use of free flaps in the feet.

Advantages of using intercostal vessels as the recipients for free flaps covering lumbar defects.

Anatomic conditions in the lumbar region can complicate procedures for covering defects. In particular, a free flap is often required when the defect is large, in which case suitable recipient vessels must be found to insure revascularization. This report concerns a 50-year-old woman with multiple basal-cell carcinomas in the lumbar radiodermatitis zone, who underwent a large resection from D10 to S2.

Population pharmacokinetics of imipenem in burn patients.

The interindividual variability of imipenem pharmacokinetic parameters in burn patients suggest that these parameters have to be estimated with a large number of patients. The aim of this study is (i) to estimate these parameters with a population pharmacokinetic approach, and (ii) to test the influence of factors on pharmacokinetics parameters. Data are provided by therapeutic drug monitoring (n = 47,118 samples) and analysed by a nonlinear mixed effect modelling method.

False aneurysm of the palmar arch in a child.

False aneurysm of the arteries of the hand are extremely rare in children, despite high frequency of hand injuries. The authors report one case of false aneurysm in the superficial palmar arch in a 5-year-old girl. The aneurysm was resected, and vascular reconstruction was performed by end-to-end microscopic anastomosis.

Population pharmacokinetics of ceftazidime in burn patients.

Aim: The aim of this study was to characterize, via a population pharmacokinetic approach, the pharmacokinetics of ceftazidime in burn patients who were not in the acute post-injury phase.

Methods: The development of the pharmacokinetic model was based on data from therapeutic drug monitoring (41 patients, 94 samples). The estimation of population pharmacokinetic parameters and the selection of covariates (age, gender, body weight, size of burn and creatinine plasma concentration) that could affect the pharmacokinetics were performed with a nonlinear mixed effect modelling method.

[Surgery of burns].

The surgical treatment of burns must provide the best conditions that assure re-epidermalisation of the burn. Two imperatives must be respected during the initial management: encourage rapid scarring of the burn as the loss of the protection of the cutaneous barrier leads to a significant risk of contamination of the burn and of generalised infection, and the quality of the burn scar (minimal retraction or hypertrophic reaction) is directly related to the duration of the scarring process; utilisation of the technique that will give the best aesthetic and functional results in treating firstly the exposed zones (face and hands) and the functional zones (flexural folds, articular regions). The surgical treatment should respect the areas that can spontaneously re-epidermalise (superficial or intermediate burns), however in the deeper lesions (second-degree or third-degree burns) the destruction of the basal layer capable of providing keratinisation and re-epidermalisation renders the recourse to skin transplantation indispensable, which must be performed before the fifteenth day in order to best avoid complications.