Fabien Boucher

In vitro and in vivo biocompatibility, bioavailability and tolerance of an injectable vehicle for adipose-derived stem/stromal cells for plastic surgery indications

Soft tissue reconstruction is a challenge in plastic surgery, when replacing lost materials and correcting contour defects. Many permanent and temporary fillers have been used to restore the volume of these lesions, but often with poor results and even complications. Adipose-derived stem/stromal cells (ASCs) and adipose tissue engineering have been suggested as valuable alternatives. In order to inject these cultured cells, it was essential to find a suitable vehicle. The purpose of this study was to evaluate Cytocare(®), an injectable medical device, composed of hyaluronic acid plus amino acids, vitamins and mineral salts. First, ASC viability and bioavailability in the 3 different available Cytocare(®) formulations using the MTT test were assessed; then an animal experiment, testing the tolerance after intradermal injections of both Cytocare(®) alone and with ASCs was carried out. Our in vitro results demonstrate a high biocompatibility of Cytocare(®) resulting in a better viability of ASCs when cultured in Cytocare(®) compared to culture medium (p < 0.05, Mann and Whitney). Cytocare(®) also permits their bioavailability and proliferation, making it a potential transfer vehicle that can retain the cells before their integration around the recipient site. Finally, our animal experiment shows that the ASC + Cytocare(®) combination is well tolerated. In conclusion, Cytocare(®) can be used as a biocompatible scaffold for cultured ASCs in therapeutic treatments, ensuring ASC bioavailability, as well as evidence of excellent tolerance in nude mice.

Superficial femoral artery perforator flap: anatomical study of a new flap and clinical cases.

Background: The medial thigh has been infrequently studied as a donor site for pedicled or free flaps. In their previous studies, the authors observed a direct cutaneous branch from the superficial femoral artery. This study aimed to investigate the anatomy and potential possibility for flap elevation (the midmedial thigh flap) on this direct branch of the superficial femoral vessels. Methods: Circumferential adipocutaneous thigh flaps were harvested from 14 fresh adult cadaver legs. The direct cutaneous branch from the superficial femoral vessels was located between the sartorius and gracilis muscles. Pedicle location, diameter, and length and position of the great saphenous vein and saphenous nerve were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area of cutaneous territory supplied by the studied perforator. Results: The pedicle was located at an average distance of 22.79 ± 1.55 cm below the pubic tubercle on the medial axis of the thigh, and it was found in 100 percent of dissections. It was always located between the sartorius and gracilis muscles, with a mean diameter of 2.82 ± 0.69 mm and mean length of 4.79 ± 0.52 cm. The average area of skin perfused was 182.24 cm2, located preferentially distal and posterior to the perforator pedicle. Two clinical cases illustrate the feasibility of the midmedial thigh perforator flap. Conclusions: The superficial femoral artery perforator flap appears to be reliable and has a constant vascular anatomy. Donor-site morbidity is low, resulting in only a vertical scar on the medial thigh. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Evaluation of Three Devices for the Isolation of the Stromal Vascular Fraction from Adipose Tissue and for ASC Culture: A Comparative Study

Adipose-derived stem/stromal cells (ASCs) reside in the stromal vascular fraction (SVF) of adipose tissue (AT) and can be easily isolated. However, extraction of the SVF from lipoaspirate is a critical step in generating ASC, and semiautomated devices have been developed to enhance the efficacy and reproducibility of the outcomes and to decrease manipulation and contamination. In this study, we compared the reference method used in our lab for SVF isolation from lipoaspirate, with three medical devices: GID SVF-1™, Puregraft™, and Stem.pras®. Cell yield and their viability were evaluated as well as their phenotype with flow cytometry. Further on, we determined their proliferative potential using population doublings (PD), PD time (PDT), and clonogenicity assay (CFU-F). Finally, we checked their genetic stability using RT-qPCR for TERT mRNA assay and karyotyping as well as their multilineage potential including adipogenic, chondrogenic, and osteogenic differentiation. Our results demonstrate that all the devices allow the production of SVF cells with consistent yield and viability, in less time than the reference method. Expanded cells from the four methods showed no significant differences in terms of phenotype, proliferation capabilities, differentiation abilities, and genetic stability.

Population pharmacokinetics and probability of target attainment of ertapenem administered by subcutaneous or intravenous route in patients with bone and joint infection

Background Ertapenem is a therapeutic option in patients with Gram-negative bone and joint infection (BJI). The subcutaneous (sc) route of administration is convenient in the outpatient setting and has shown favourable pharmacokinetics (PK), but available data on ertapenem are limited. Objectives To perform population PK analysis and pharmacokinetic/pharmacodynamic (PK/PD) simulation of ertapenem administered by the intravenous (iv) or sc route to patients with BJI. Patients and methods This was a retrospective analysis of PK data collected in patients with BJI who received iv or sc ertapenem. Measured ertapenem concentrations were analysed with a non-parametric population approach. Then, simulations were performed based on the final model to investigate the influence of ertapenem route of administration, dosage and renal function on the probability of achieving a pharmacodynamic (PD) target, defined as the percentage of time for which free plasma concentrations of ertapenem remained above the MIC (fT>MIC) of 40%. Results Forty-six PK profiles (13 with iv and 33 with sc ertapenem) with a total of 133 concentrations from 31 subjects were available for the analysis. A two-compartment model with linear sc absorption and linear elimination best fitted the data. Creatinine clearance was found to significantly influence ertapenem plasma clearance. Simulations showed that twice daily dosing, sc administration and renal impairment were associated with an increase in fT>MIC and target attainment. Conclusions Our results indicate that 1 g of ertapenem administered twice daily, by the iv or sc route, may optimize ertapenem exposure and achievement of PK/PD targets in patients with BJI.

Chronic Propionibacterium acnes prosthesis joint infection manifesting as a large abscess with gas, without prosthesis loosening.

A 78-year-old woman with diabetes, hypertension and severe omarthrosis, had a left total shoulder arthroplasty in May 2010. In September 2010, the patient developed axillar abscess, without fever or pain, which was incised. Propionibacterium acnes grew in cultures and the patient received amoxicillin-clavulanate for 10 days. In 2011, it reoccurred, with abscess formation that gradually increased in size during several weeks and reached 5×8 cm in diameter (figure 1A). C reactive protein was elevated (94 mg/L), but the patient did not have fever. X-ray examination did not show prosthesis loosening, but a distal cortical thickening of …

Innovations for the treatment of a complex bone and joint infection due to XDR Pseudomonas aeruginosa including local application of a selected cocktail of bacteriophages

found a high prevalence of ESBL producers, but no CPE. In conclusion, we report two temporally and geographically linked patients with community-onset urinary tract infection caused by the same OXA-48-producing E. coli clone. The association between OXA-48 and Cambodia in NZ suggests the Cambodian patient may have acquired the organism during recent travel and indirectly transmitted to the second patient via unknown community transmission pathways. It is possible that OXA-48-positive CPE are under-recognized in NZ due to the challenges of laboratory detection. Screening with adequate selective media for CPE is highly recommended. The forthcoming national response plan to CPE in NZ has potential to help address some of these issues.

Diagnostic de l’infection d’une plaie chronique et principes de traitement

Les plaies chroniques representent un probleme clinique frequent dont la prise en charge est mal codifiee. La colonisation bacterienne est systematique, et peut evoluer vers une infection dont le diagnostic est parfois difficile. Les situations urgentes, severes ou complexes, telles que les dermohypodermites bacteriennes necrosantes et les osteites de contiguite, doivent etre connues et recherchees systematiquement. La documentation microbiologique est complexe, l’indication et la nature des prelevements devant etre de qualite pour permettre de faire la part entre la flore colonisante et celle responsable de l’infection. La prise en charge doit etre pluridisciplinaire, incluant soins locaux, debridement chirurgical, antibiotherapie adaptee, et gestion systematique des pathologies sous-jacentes ainsi que des facteurs etiologiques, incluant diabete et insuffisances vasculaires. Les formes les plus complexes doivent etre gerees en centre de reference.

Incisions et technique opératoire de base du lifting cervicofacial

Cervicofacial lifting is one of the most iconic procedure of plastic surgery and is about hundred years old. In the following chapters of this report, numerous technical points will be specify. A baseline reliable and reproducible technique, appealing to the largest possible audience is presented in order to begin this surgery in optimum conditions. Pre- and postoperative management is also exposed. The aim of this chapter is to precise incisions and baseline operative technique of cervicofacial lifting, with description of SMAS and platysma suspensions as well as complementary procedures like liposuccion and lipofilling. This chapter will lay the foundation of more complex elements that will be described in the various following chapters.

Hand Allograft Saved by an Ultrathin Groin Flap

Summary: We report a case of a young double-hand allotransplant patient who presented with a full-thickness skin necrosis of the dorsum of the left hand after vascular compromise of the allotransplantation. Considering the lack of viable dorsal tissue overlying the extensor tendons and the need for early hand rehabilitation, an ultrathin pedicled groin flap was used for the coverage. This procedure resulted in salvaging the allotransplantation, and the patient was able to successfully return to work after his surgery. To our knowledge, this is the only case of an upper extremity allotransplant salvaged by a pedicled flap.

Cirugía estética genital

La cirugia estetica genital tiene como finalidad mejorar el aspecto estetico y funcional de los organos genitales externos. Ha experimentado un desarrollo importante desde la decada de 1980. En las mujeres, la intervencion mas frecuente es la ninfoplastia de reduccion, que consiste en disminuir el tamano de los labios menores. La tecnica de las «V invertidas» permite reducir la region con mayor excedente a la vez que conserva un contorno armonioso y fisiologico. En este articulo, se describen otras intervenciones para el tratamiento de las distintas estructuras que componen los organos genitales femeninos. En el varon, la percepcion del tamano del pene puede ser muy variable segun los pacientes, y el malestar subjetivo puede causar un autentico complejo, asi como un autentico obstaculo para las relaciones intimas. Las distintas tecnicas permiten mejorar el aspecto del pene en estado de flacidez. La demanda es principalmente estetica, porque mas del 80% de los varones operados tienen un pene dentro del rango de la normalidad. El alargamiento del pene y el aumento de su calibre son las intervenciones mas frecuentes.