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International audience; BACKGROUND: Reverse anterolateral thigh perforator (ALTp) pedicle flap can be used to reconstruct perigenicular defect thanks to the anastomoses between the descending branch of the lateral circumflex femoral artery (LCFA) and the perigenicular network. In a few cases, however, patients do not present any ALTp. We hypothesized that, in such cases, an adjacent perforator, the tensor fascia latae perforator (TFLp), emerging from the LCFA ascending branch, could be used instead. To assess the feasibility of this technique, a radiological study was conducted. A first patient was treated using this option. METHODS: Sixty lower limb computed tomography were analyzed. The first treated patient was a 50-years-old man suffering from a 5-mm chronic bone exposure and osteomyelitis. Other reconstructive options were not indicated since he presented a multiscarry leg, severe arteriopathy, and no ALTp. A TFLp flap was raised, and the LCFA ascending and descending branches were dissected in continuity. After ligation of the LCFA, the blood flow reversed in the descending branch to irrigate the flap through the ascending branch. RESULTS: A TFL perforator was observed in all the cases of the radiological study. The LCFA branching pattern was compatible with achieving a reverse TFL perforator flap in 43 cases (72%). The average pedicle length was 32 cm (22-38 cm). In the first clinical case, the flap covered the defect easily. After three months, the patient showed no evidence of infection recurrence and recovered a painless walk. CONCLUSION: The reverse TFLp flap can be a suitable option for perigenicular reconstruction.

International audience; Copper substitution together with nano-structuring are applied with the aim to increase the bactericidal performances of the rocksalt-type MgO oxide. The partial substitution of magnesium ions with Cu2+ has been successfully achieved in both micrometer- and nanometer-sized particles of MgO up to 20 mol% in increments of 5 mol%. Microstructural analyses using the Integral Breadth method revealed that the thermal decomposition of the single source precursor Mg1-xCux(OH)2-2y(CO3)y.zH2O at 400 °C creates numerous defects in 10–20 nm-sized particles of Mg1-xCuxO thus obtained. These defects make the surface of nanoparticles highly reactive towards the sorption of water molecules, to the extent that the cubic cell a parameter in as-prepared Mg1-xCuxO expands by +0.24% as soon as the nanoparticles are exposed to ambient air (60% RH). The hydration of Mg1-xCuxO particles in liquid water is based on a conventional dissolution-precipitation mechanism. Particles of a few microns in size dissolve all the more slowly the higher the copper content and only Mg(OH)2 starts precipitating after 3 h. In contrast, the dissolution of all 10–20 nm-sized Mg1-xCuxO particles is complete over a 3 h period and water suspension only contains 4–12 nm-sized Mg1-xCux(OH)2 particles after 3 h. Thereby, the bactericidal activity reported for water suspension of Mg1-xCuxO nanoparticles depends on the speed at which these nanoparticles dissolve and Mg1-xCux(OH)2 nanoparticles precipitate in the first 3 h. Only 10 mol% of cupric ions in MgO nanoparticles are sufficient to kill both E. coli and S. aureus with a bactericidal kinetics faster and reductions in viability at 3 h (6.5 Log10 and 2.7 Log10, respectively) higher than the conventional antibacterial agent CuO (4.7 Log10 and 2 Log10 under the same conditions). EPR spin trapping study reveals that “hydroxylated” Mg0.9Cu0.1O as well as Mg0.9Cu0.1(OH)2 nanoparticles produce more spin-adducts with highly toxic hydroxyl radicals than their copper-free counterparts. The rapid mass adsorption of Mg0.9Cu0.1(OH)2 nanoparticles onto the cell envelopes following their precipitation together with their ability to produce Reactive Oxygen Species are responsible for the exceptionally high bactericidal activity measured in the course of the hydroxylation of Mg0.9Cu0.1O nanoparticles.

International audience; A 75 years old man with previous aortic abdominal aneurysm surgery through a transverse laparotomy underwent bilateral internal thoracic artery to coronary artery bypass grafting. He immediately thereafter developed a severe chest and upper abdominal walls ischemia with metabolic acidosis, and finally deep sternum wound infection and upper abdominal wall necrosis. He benefitted from sternal reconstruction and vaccum assisted treatment, with delayed pectus major flap reconstruction. Chest and abdominal wall infarction following bilateral internal thoracic artery (BITA) harvesting is a very rare but life-threatening complication. Caution use of BIMA should be in order in patients with inferior epigastric artery flow impairment.

Background A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated. Methods Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e.,, additional microbiological findings at reconstruction) and treatment failure were assessed using binary logistic regression and Kaplan–Meier curve analysis. Results Sixty-four pressure ulcer-related pelvic osteomyelitis in 61 patients (age, 47 [IQR 36–63]) were included. Osteomyelitis was mostly plurimicrobial (73%), with a predominance of S. aureus (47%), Enterobacteriaceae (44%), and anaerobes (44%). Flap coverage was performed after 7 (IQR 5–10) weeks of NPT, with 43 (68%) positive bone samples among which 39 (91%) were superinfections, associated with a high ASA score (OR, 5.8; P = 0.022). An increased prevalence of coagulase negative Staphylococci (P = 0.017) and Candida (P = 0.003) was observed at time of flap coverage. An ESBL Enterobacteriaceae was found in one (12%) patients, associated with fluoroquinolone consumption (OR, 32.4; P = 0.005). Treatment duration was as 20 (IQR 14–27) weeks, including 11 (IQR 8–15) after reconstruction. After a follow-up of 54 (IQR 27–102) weeks, 15 (23%) failures were observed, associated with previous pressure ulcer (OR, 5.7; P = 0.025) and Actinomyces infection (OR, 9.5; P = 0.027). Conclusion Pressure ulcer-related pelvic osteomyelitis is a difficult-to-treat clinical condition, generating an important consumption of broad-spectrum antibiotics. Carbapenem should be reserved for ESBL at-risk patients only, including those with previous fluoroquinolone use. The uncorrelation between outcome and the debridement-to-reconstruction interval argue for a short sequence to limit the total duration of treatment. Disclosures T. Ferry, HERAEUS: Consultant, Speaker honorarium