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To evaluate the surgical and functional outcomes of urethral reconstruction associated with phalloplasty, depending on the surgical techniques and patient history.We conducted a single-centre retrospective study including 89 patients who underwent phalloplasty with urethral reconstruction between 2007 and 2018. Patients included were trans-male patients undergoing gender-affirming surgery and cis-male patients undergoing penile reconstruction after trauma, congenital malformation, or cancer. Urethral reconstructions were performed by free flap or skin graft (total or thin). Secondary urethroplasty may include direct vision urethrotomy, excision-anastomosis, or augmentation urethroplasty (skin graft, buccal mucosa graft). Patient demographics, medical history, peri- and postoperative data were collected from patient files. Functional results were evaluated using individual questionnaires.The mean (±sd) follow-up duration was 5.5 (±3.7) years. No significant difference was found for total urethral complication rate (fistula and/or stricture) according to type of urethral construction (70.9% for free flap urethra vs 73.5% for skin graft urethra; P = 0.911), nor according to the patient's grounds for surgery (72.7% for cis-male vs 71.8% for trans-male patients; P = 1). A total of 36 patients (40.5%) answered the functional questionnaire, of whom 80.5% reported usually voiding while standing and 47.5% were comfortable with urinating in public.Urethral construction in phalloplasty is associated with a high complication and revision rate regardless of the type of urethral reconstruction. Voiding in a standing position is generally possible but should not conceal feeble functional results.

The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3 cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.

Toxic hydroxyl radicals produced by Cu(OH)2 nanorods completely disinfect water contaminated with S. aureus and E. coli after only 180 min.

International audience

International audience; Both nanometer-sized CuO and MgO particles exhibit bactericidal activities against Staphylococcus aureus and Escherichia coli, two bacteria causing healthcare-associated infections. The solid solution Cu1−xMgxO is potentially interesting for biomedical applications as one of the compositions could have a much higher bactericidal activity than the parent CuO and MgO oxides considered separately. But, to date, no Vegard’s law proves the real existence of such a solid solution. This study was aimed at shedding light on the solubility of Mg2+ ions in CuO nanoparticles and its impact on the free oxygen radicals they produce, the quantity of which determines their bactericidal performance. The solid solution Cu1−xMgxO does exist and particles were synthesized as nanorods of 50–60 nm length by thermally decomposing at 400 °C the single source precursors Cu1−xMgx(OH)2. Vegard’s laws exist only in the compositional range 0 ≤ x ≤ 0.1, due to the low capacity of the distorted NaCl-type structure to accommodate regular coordination [MgO6] octahedra. Only neutron diffraction allowed the detection of the small amount of MgO nanoparticles present as impurity in a 10 g sample beyond the solubility limit of x = 0.1. In this series, CuO nanorods remain the most active against E. coli and S. aureus with reduction in viability of 99.998% and 98.7% after 180 min in water, respectively. Our synthesis route has significantly increased the activity of pure CuO nanoparticles beyond the values reported so far, especially against E. coli. The bactericidal performances of CuO and the magnesium-substituted counterparts (i.e. Cu1−xMgxO) are not linked to cupric ions they release in water since their mass concentrations after 180 min are much lower than minimal concentrations inhibiting the growth of E. coli and S. aureus. TheseCuO nanorods kill bacteria in water because they produce a large quantity of free oxygen radicals in the presence of H2O2 only, the majority of which are highly toxic HO• radicals. Mg2+ ions have a detrimental effect on this production, thus explaining the lowest bactericidal performance of Cu1−xMgxO nanorods. Definitive knowledge of the toxicity of Cu1−xMgxO nanoparticles towards bacteria in water is now available.

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.

A 75 years old man with previous aortic abdominal aneurysm surgery through a transverse laparotomy underwent bilateral internal mammary artery (BIMA) to coronary artery bypass grafting (CABG). 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 BIMA 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.

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.

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 Cu

International audience; Brucite Mg(OH)2 belongs to a family of two-dimensional compounds with a CdI2-type structure built up from layers of edge-sharing octahedra delineating 2D galleries. In the current study, nanometer-sized platelets of copper substituted Mg(OH)2 were prepared by co-precipitation at room temperature in mixed alkaline (NaOH/Na2CO3) medium. Very weak substitution of a few hydroxyl ions by carbonate groups was highlighted at first by infrared spectroscopy and then quantified by thermogravimetric (TG) and mass spectrometric (MS) evolved gas analyses. The presence in a very low amount of water molecules in the galleries induces disorder in the stacking of layers of edge-sharing octahedra along the c-axis. The dehydration of the hydroxides taking place below 225 °C preserves the brucite-type structure of the samples while suppressing the stacking disorder. Copper substitution greatly enhances the bactericidal activity of nanometer-sized platelets of brucite against two bacteria frequently involved in healthcare-associated-infections. 10 mol% of cupric ions in Mg(OH)2 (a copper loading of 0.102 mg mL-1 in the suspension) were sufficient to induce, after 3 h in contact, 100% and 99.3% reductions in viability of Gram-negative E. coli and Gram-positive S. aureus, respectively (reductions as low as 23% and 48% are reported for the parent compound Mg(OH)2 in the same conditions). A good compromise betweenfast bactericidal kinetics and a high reduction in viability is reached by the 15 mol% copper-substituted Mg(OH)2 hydroxide. Its use gives the opportunity to five-fold reduce the copper loading of the bactericidal agent while being at least equally or even more efficient compared to the conventional CuO (a Cu loading of 0.799 mg mL-1 and 0.154 mg mL-1 in the suspension of CuO and 15 mol% copper substituted Mg(OH)2 particles, respectively).

Thoracic wall reconstruction after oncologic resection remains a complex form of surgery that implies a multidisciplinary approach. The purpose of this study is to present our experience in full thickness thoracic wall reconstruction after tumor resection. A retrospective study, including patients who were operated for full thickness thoracic wall defects after tumor resection, was undertaken. The type of bone and soft tissue reconstruction and the patient outcome was evaluated. Between 1998 and 2011, a total of ten patients underwent full thickness thoracic wall resection and reconstruction. All patients were reconstructed during a single-stage surgery. In all cases, bone reconstruction was accomplished by a polytetrafluoroethylene patch (Gore-Tex), while soft tissue reconstruction required either muscle or musculocutaneous pedicled flaps such as latissimus dorsi, rectus abdominis, or pectoralis major flaps. In this series, no major complications (infection, respiratory or cardiac failure, or deaths) were detected. Usually treated as palliative surgery, thoracic wall resection and immediate reconstruction allows large wall resection which, in association with adjuvant therapy, can potentially cure patients who have had a primary tumor or a unique metastasis. Level of Evidence: Level IV, therapeutic study.

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