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3 results on '"Excision-graft"'

1. The A2B trial, antibiotic prophylaxis for excision-graft surgery in burn patients: a multicenter randomized double-blind study

Author

Dépret, François, Farny, Boris, Jeanne, Mathieu, Klouche, Kada, Leclerc, Thomas, Nouette-Gaulain, Karine, Pantet, Olivier, Rémerand, Francis, Roquilly, Antoine, Rousseau, Anne-Françoise, Sztajnic, Simon, Wiramus, Sandrine, Vicaut, Eric, and Legrand, Matthieu

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Infectious Diseases, Sepsis, Clinical Trials and Supportive Activities, Clinical Research, Antimicrobial Resistance, Patient Safety, Physical Injury - Accidents and Adverse Effects, Prevention, Hematology, 6.4 Surgery, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Infection, Adult, Anti-Bacterial Agents, Antibiotic Prophylaxis, Burns, Double-Blind Method, Humans, Multicenter Studies as Topic, Prospective Studies, Randomized Controlled Trials as Topic, Surgical Wound Infection, Burn, Antibiotic prophylaxis, Excision-graft, A2B trial investigators, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, General & Internal Medicine, Clinical sciences, Epidemiology, Health services and systems
Abstract

BackgroundThe indication for antibiotic prophylaxis in burn patients remains highly controversial, with no consensus having been reached. The objective of antibiotic prophylaxis is to reduce the risk of postoperative local and systemic infections. Burn surgery is associated with a high incidence of bacteremia, postoperative infections, and sepsis. However, antibiotic prophylaxis exposes patients to the risk of selecting drug-resistant pathogens as well as to the adverse effects of antibiotics (i.e., Clostridium difficile colitis). The lack of data precludes any strong international recommendations regarding perioperative prophylaxis using systemic antibiotics in this setting. The goal of this project is therefore to determine whether perioperative systemic antibiotic prophylaxis can reduce the incidence of postoperative infections in burn patients.MethodsThe A2B trial is a multicenter (10 centers), prospective, randomized, double-blinded, placebo-controlled study. The trial will involve the recruitment of 506 adult burn patients with a total body surface area (TBSA) burn of between 5 and 40% and requiring at least one excision-graft surgery for deep burn injury. Participants will be randomized to receive antibiotic prophylaxis (antibiotic prophylaxis group) or a placebo (control group) 30 min before the incision of the first two surgeries. The primary outcome will be the occurrence of postoperative infections defined as postoperative sepsis and/or surgical site infection and/or graft lysis requiring a new graft within 7 days after surgery. Secondary outcomes will include mortality at day 90 postrandomization, skin graft lysis requiring a new graft procedure, postoperative bacteremia (within 48 h of surgery), postoperative sepsis, postoperative surgical site infection, number of hospitalizations until complete healing (> 95% TBSA), number of hospitalization days living without antibiotic therapy at day 28 and day 90, and multiresistant bacterial colonization or infection at day 28 and day 90.DiscussionThe trial aims to provide evidence on the efficacy and safety of antibiotic prophylaxis for excision-graft surgery in burn patients.Trial registrationClinicalTrials.gov NCT04292054 . Registered on 2 March 2020.

Published
2020

2. The A2B trial, antibiotic prophylaxis for excision-graft surgery in burn patients: a multicenter randomized double-blind study

Author

Francis Remerand, Kada Klouche, Simon Sztajnic, François Dépret, Boris Farny, Eric Vicaut, Mathieu Jeanne, Antoine Roquilly, Matthieu Legrand, Olivier Pantet, Anne-Françoise Rousseau, Thomas Leclerc, Karine Nouette-Gaulain, Sandrine Wiramus, Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Centre hospitalier Saint Joseph - Saint Luc [Lyon], Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université de Paris (UP), Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Recherche translationelle relations hôte-pathogènes, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Hôpital d'instruction des Armées Percy, Service de Santé des Armées, Hôpital d'Instruction des Armées du Val de Grâce, Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Laboratoire Maladies Rares: Génétique et Métabolisme (Bordeaux) (U1211 INSERM/MRGM), Université de Bordeaux (UB)-Groupe hospitalier Pellegrin-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier Universitaire de Liège (CHU-Liège), Département d'Anesthésie-Réanimation [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of California [San Francisco] (UCSF), University of California, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Herrada, Anthony, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Université Paris Cité (UPCité), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), University of California [San Francisco] (UC San Francisco), and University of California (UC)

Subjects
Excision-graft, Burn injury, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Antibiotics, Medicine (miscellaneous), Cardiorespiratory Medicine and Haematology, Study Protocol, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Multicenter Studies as Topic, Pharmacology (medical), 030212 general & internal medicine, Prospective Studies, Antibiotic prophylaxis, Randomized Controlled Trials as Topic, Hematology, 3. Good health, Anti-Bacterial Agents, Infectious Diseases, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, 6.1 Pharmaceuticals, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Patient Safety, Burns, Infection, 6.4 Surgery, Adult, medicine.medical_specialty, Physical Injury - Accidents and Adverse Effects, medicine.drug_class, Clinical Trials and Supportive Activities, Clinical Sciences, Burn, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, A2B trial investigators, Sepsis, 03 medical and health sciences, Double-Blind Method, Clinical Research, General & Internal Medicine, medicine, Humans, Surgical Wound Infection, Adverse effect, business.industry, Prevention, Evaluation of treatments and therapeutic interventions, 030208 emergency & critical care medicine, Perioperative, medicine.disease, Surgery, Cardiovascular System & Hematology, Bacteremia, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Antimicrobial Resistance, business, Total body surface area
Abstract

Background The indication for antibiotic prophylaxis in burn patients remains highly controversial, with no consensus having been reached. The objective of antibiotic prophylaxis is to reduce the risk of postoperative local and systemic infections. Burn surgery is associated with a high incidence of bacteremia, postoperative infections, and sepsis. However, antibiotic prophylaxis exposes patients to the risk of selecting drug-resistant pathogens as well as to the adverse effects of antibiotics (i.e., Clostridium difficile colitis). The lack of data precludes any strong international recommendations regarding perioperative prophylaxis using systemic antibiotics in this setting. The goal of this project is therefore to determine whether perioperative systemic antibiotic prophylaxis can reduce the incidence of postoperative infections in burn patients. Methods The A2B trial is a multicenter (10 centers), prospective, randomized, double-blinded, placebo-controlled study. The trial will involve the recruitment of 506 adult burn patients with a total body surface area (TBSA) burn of between 5 and 40% and requiring at least one excision-graft surgery for deep burn injury. Participants will be randomized to receive antibiotic prophylaxis (antibiotic prophylaxis group) or a placebo (control group) 30 min before the incision of the first two surgeries. The primary outcome will be the occurrence of postoperative infections defined as postoperative sepsis and/or surgical site infection and/or graft lysis requiring a new graft within 7 days after surgery. Secondary outcomes will include mortality at day 90 postrandomization, skin graft lysis requiring a new graft procedure, postoperative bacteremia (within 48 h of surgery), postoperative sepsis, postoperative surgical site infection, number of hospitalizations until complete healing (> 95% TBSA), number of hospitalization days living without antibiotic therapy at day 28 and day 90, and multiresistant bacterial colonization or infection at day 28 and day 90. Discussion The trial aims to provide evidence on the efficacy and safety of antibiotic prophylaxis for excision-graft surgery in burn patients. Trial registration ClinicalTrials.gov NCT04292054. Registered on 2 March 2020

Published
2020
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3. Chirurgie des déformations de la verge de l’adulte, quelle technique pour quelle déformation ?

Author

El Osta, R. and Chevallier, D.

Abstract

Résumé Introduction La chirurgie est souvent le traitement de référence des déformations de la verge. Devant la présence de multiples techniques possibles et leurs résultats différents sur la correction de la déformation, le raccourcissement, le risque d’impuissance et le risque d’insensibilité, il est nécessaire d’avoir une stratégie thérapeutique personnalisée. Méthodes Mise au point des différentes techniques chirurgicales dans le traitement des déformations de la verge. Recherche bibliographique à l’aide de la base de données Medline en utilisant les mots clés : Lapeyronie, courbure congénitale, Yachia, Nesbit, incision-greffe, Excision-greffe. Résultats Orientation du choix de la technique selon la déformation et l’étiologie. Discussion Bilan préopératoire et suivi postopératoire de cette chirurgie. Summary Introduction Surgery is generally regarded as the best treatment for penis deformations. Due to the multitude of techniques that can bring non-negligible side effects – i.e. shortening, impotence and the risk of insensitivity – it is necessary to devise a customized treatment strategy. Methods Presentation of the different surgical techniques used in the treatment of penis deformations. Bibliographic research through the Medline database by using the following keywords: Peyronie's disease, congenital curvature, Yachia, Nesbit, incision-graft, excision-graft. Results Recommendation for selecting a suitable technique according to the deformity and its etiology. Discussion Preoperative assessments and postoperative follow-up of the surgery. [ABSTRACT FROM AUTHOR]

Published
2014
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