Publications by authors named "Camille Choufani"

23 Publications

  • Page 1 of 1

Challenges of the induced-membrane technique in the reconstruction of traumatic tibial defect with limited resources : a cohort study.

Acta Orthop Belg 2020 Dec;86(4):606-613

This study sought foremost to evaluate the outcomes of applying the induced membrane technique (IMT) for tibia reconstruction within the context of a sub-Saharan Africa trauma center. Second, this study aimed to elucidate the conditions of IMT usage in a limited-resource setting. A retrospective study was performed among patients treated via IMT for posttraumatic tibial bone defects who had follow-up data available for at least 12 months. Eleven patients with a mean age of 36 years were included. All presented with an infected multi-tissue defect. The mean length of the tibia defect was 4.4 cm and the mean area of the soft-tissue loss was 32 cm . Pedicled flap coverage was required in all cases. At the mean follow-up time of 15 months bone union was achieved in nine of 11 cases, after additional inter-tibiofibular grafting was performed in four cases. Infection recurrence was noted in five of 11 cases. Most patients presented medium-quality soft-tissue coverage and suboptimal function. IMT may represent a valuable option for tibia reconstruction with limited surgical resources in cases where appropriate infection control and stable soft-tissue coverage can be ensured.
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December 2020

[The return to socio-professional life after a severe limb trauma].

Rev Infirm 2021 Jan 4;70(267):31-33. Epub 2020 Dec 4.

Servicede chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

The occurrence of severe limb trauma is a brutal event for all patients in any context. Many questions quickly arise, with a very broad scope - from the course of the intervention to family and social reintegration. The nurse has an essential role in listening, educating and supporting the patient before and after the operation. In addition to reassurance, she plays a central role in organising the return home and helping the patient to resume socio-professional activities.
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http://dx.doi.org/10.1016/j.revinf.2020.11.011DOI Listing
January 2021

[The basics of immobilisation].

Rev Infirm 2021 Jan 4;70(267):28-30. Epub 2020 Dec 4.

Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

Treatments for a patient with severe limb trauma, require immobilisation in order to stabilise and thus allow bone consolidation or ligament healing or skin protection.
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http://dx.doi.org/10.1016/j.revinf.2020.11.021DOI Listing
January 2021

[Dressing management in limb traumatology].

Rev Infirm 2021 Jan 4;70(267):26-27. Epub 2020 Dec 4.

Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

The nurse's role in the management of dressings in limb trauma is essential: conditioning of the patient, correct and complete assessment of the site concerned, before care is provided. She is a privileged partner in planning the follow-up. At each stage, the nurse must be aware of the tasks to be carried out so that the overall management leads to rapid and correct healing.
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http://dx.doi.org/10.1016/j.revinf.2020.11.010DOI Listing
January 2021

[Post-operative monitoring of a patient with severe limb trauma].

Rev Infirm 2021 Jan 4;70(267):24-25. Epub 2020 Dec 4.

Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

In the postoperative monitoring of a patient with severe limb trauma, the nurse's objectives are multiple: prevention and screening of complications, follow-up care, compliance with postoperative instructions. Presentation of the key elements of this monitoring, which must be systematised and personalised.
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http://dx.doi.org/10.1016/j.revinf.2020.11.009DOI Listing
January 2021

[Conditioning of the patient by the nurse in the emergency reception service].

Rev Infirm 2021 Jan 4;70(267):22-23. Epub 2020 Dec 4.

Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

The role of the nurse in the emergency reception service has become more complex in recent years in view of the evolution of these services. The particularity of this position lies in its autonomy, adaptation, adjustment, capacity for anticipation and participation in the diagnosis. Illustration of the central role of the nurse in the multidisciplinary care chain of a patient with limb trauma.
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http://dx.doi.org/10.1016/j.revinf.2020.11.008DOI Listing
January 2021

[Initial gestures in response to victims of limb trauma in pre-hospital care].

Rev Infirm 2021 Jan 4;70(267):20-21. Epub 2020 Dec 4.

Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

Limb trauma is a frequent pathology in pre-hospital care. The first responder caregiver plays a crucial role in terms of the application of the initial care in order to save the limb and life of the patient and to limit the functional consequences. He has to follow strict rules of safety and efficiency. The quality of his initial assessment will guide him towards the most appropriate care and the appropriate chronology.
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http://dx.doi.org/10.1016/j.revinf.2020.11.007DOI Listing
January 2021

Parcours de soins du patient traumatisé grave des membres.

Authors:
Camille Choufani

Rev Infirm 2021 Jan 3;70(267):15. Epub 2020 Dec 3.

Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

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http://dx.doi.org/10.1016/j.revinf.2020.11.005DOI Listing
January 2021

[Nursing care on an external fixator].

Rev Infirm 2020 Nov 28;69(265):42-43. Epub 2020 Sep 28.

Service de chirurgie orthopédique, Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; Service de chirurgie orthopédique, Hôpital d'instruction des armées Saint-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France. Electronic address:

The external fixator is one of the treatments for fractures. It is classically used for serious fractures, polytraumatized patients or when there is a large influx of patients. The resulting paramedical care, which is often unknown, must be rigorous in order to avoid minor and frequent, or serious but less frequent, complications. The stock of what the caregiver must master in this regard: local care, information, monitoring.
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http://dx.doi.org/10.1016/j.revinf.2020.09.011DOI Listing
November 2020

Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed in Chad.

Eur J Trauma Emerg Surg 2020 Aug 28. Epub 2020 Aug 28.

Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France.

Purpose: We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad.

Methods: A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application.

Results: Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage.

Conclusions: This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures.
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http://dx.doi.org/10.1007/s00068-020-01471-5DOI Listing
August 2020

Evaluation of a fellowship abroad as part of the initial training of the French military surgeon.

BMJ Mil Health 2020 Feb 2. Epub 2020 Feb 2.

Department of Traumatology and Orthopedics, HIA Percy, Clamart, France.

Introduction: Military surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment.

Methods: This study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents' first foreign deployment.

Results: Sixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10.

Conclusion: A fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees' feedback confirms its relevance.
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http://dx.doi.org/10.1136/jramc-2019-001303DOI Listing
February 2020

The medical and operational impact of the deployment of a scanner within Role 2 in Mali for the French army.

Injury 2020 Jan 20;51(1):66-69. Epub 2019 Sep 20.

Orthopaedic Surgery Department, Military Teaching Hospital Bégin, Saint-Mandé, France; Val de Grace Military School, 2 place A. Laveran, Paris, France.

Introduction: According to the NATO classification, the difference between Role 2 and Role 2+ is the presence of extra diagnostic and therapeutic means, including the deployment of a scanner. The aim of this study is to analyze the impact of this deployment at the front, in the Gao French Role 2 (Mali). Our main hypothesis is that the presence of a scanner at the front improves the servicemen's diagnostic and therapeutic management abilities. Secondly that scanner holds strategic relevance by limiting the repatriation of servicemen on medical grounds.

Materials And Methods: A prospective analytical observational study was conducted over 6 months within Gao's Role 2. All the French military patients who received a scanner were involved. The collected data was epidemiological, clinical and radiological in nature, and included the results from the scanner and data regarding the operational impact (repatriation). The principal judgment criterion was the rate of modification of the therapeutic decision. The secondary criterion was the modification of the repatriation decision on medical grounds.

Results: Of the 45 patients examined, in 14 cases (31.1%), performing a scanner changed patients' therapeutic management in relation to the management, which would have been conducted in the scanner's absence. For 12 of these patients (85.7%), the indication of the scanner concerned visceral or cranium-spine pathologies. For 33 patients (73.3%), the scanner enabled diagnosis via the elimination of an organic injury or a severity criterion. The repatriation decision remained unchanged for many patients.

Discussion: The scanner appears to be a significant factor in the initial therapeutic decision. Scanning made it possible to clarify the diagnosis and to better adapt the initial therapeutic decision. In contrast, the operational impact was null. The literature highlights the relevance of scanner in surgical abstention (limiting unnecessary operative procedures), and for the visceral, cranium-cerebral and spine pathologies in an emergency.

Conclusion: The scanner, a heavy logistic unit deployed within a forward surgical unit, holds therapeutic relevance for French servicemen's management with an important medical service provided for the therapeutic choices, although its operational impact has yet to be demonstrated.
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http://dx.doi.org/10.1016/j.injury.2019.09.029DOI Listing
January 2020

[Diagnosing textiloma post-surgery].

Rev Infirm 2019 Oct;68(254):44-46

Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France.

During care follow-up, specifically local post-operative care, nurses closely monitor the surgical site both for healing and for local, regional or general risk of infection. In this context, they are on the front line of identifying and reporting any suspicious clinical conditions. We use the example of a patient who presented with textiloma following orthopaedic shoulder surgery.
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http://dx.doi.org/10.1016/j.revinf.2019.08.008DOI Listing
October 2019

Early Ultrasound Follow-Up of Extension-Type Supracondylar Fractures Treated by the Collar-and-Cuff (Blount) Technique.

Pediatr Emerg Care 2020 Apr;36(4):187-191

From the The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases.

Background: Extension-type supracondylar fractures can be treated with external immobilization, with the elbow flexed 100°. However, this technique requires early evaluation by true lateral x-ray of the elbow to detect secondary fracture displacement.

Questions/purpose: The purpose of this work is to evaluate whether ultrasound imaging is suitable for demonstrating initial reduction of supracondylar fractures and early secondary displacement of the fracture.

Methods: Fourteen patients aged 3 to 7 years (mean, 4.8 years) were treated by closed reduction under general anesthesia and immobilization with a collar and cuff. All patients had early postoperative x-rays and ultrasonography on day 1, as well as day 8 x-rays and ultrasonography. Ultrasonograms were performed by an experienced senior radiologist.

Results: In all cases, a complete reduction was confirmed at initial follow-up on both sonogram and intraoperative fluoroscopy. In 13 of 14 cases, no secondary displacement of the fracture was noted at day 8 on either ultrasonography or x-ray images. In 1 case, a secondary displacement was noted at day 8 on ultrasonography and confirmed by the lateral x-ray.

Conclusions: Our study found a complete agreement assessing the quality of intraoperative reduction of supracondylar fractures by radiographs and ultrasonography. These results confirm that ultrasound imaging is suitable for demonstrating secondary displacements of supracondylar fractures in children. We postulate that in Gartland types II and III fractures treated by Blount procedure, a negative ultrasound result at day 8 follow-up may reduce the need for further radiographs. However, in any doubtful situation, the need for conventional radiographs remains.

Level Of Evidence: Diagnostic study, level II.
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http://dx.doi.org/10.1097/PEC.0000000000001822DOI Listing
April 2020

A growing stake in orthopaedic surgery and traumatology for the future management of obese patients.

Acta Orthop Belg 2018 Dec;84(4):377-383

The prevalence of obesity is increasing. In orthopaedic surgery, the impact of obesity is felt. The aim is to take stock of the consequences of obesity for patients at each stage of management. In this mini-review, we identify the main pathophysiological factors, specific orthopaedic complications and consequences to consider at each stage of management. Obese patients are subjected to a chronic inflammatory state and biomechanical stress. This augments the risk of sepsis and trauma, musculoskeletal damage, the frequency of organ failure and thus, morbidity and mortality. This results in more complex and longer supportive care. At each stage of care, surgeons and doctors have to adapt to optimize care. It is necessary to obtain timely and accurate information from the patient. Patient information is necessary. Being obese in orthopaedics is a factor in poor prognosis. Treatments need to be adapted. This requires specific preparation at each step.
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December 2018

Use of intramedullary nailing in poor sanitary conditions: French Military Medical Service experience.

Orthop Traumatol Surg Res 2019 02 10;105(1):173-177. Epub 2019 Jan 10.

Service de chirurgie orthopédique et traumatologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.

Introduction: Intramedullary (IM) nailing is the gold standard for treating long bone fractures in developed countries because of its minimally-invasive application and good biomechanical properties. In precarious conditions, external fixation or open plate fixation are often performed because surgeons do not have the means to carry out IM nailing. However, these procedures can lead to infection-related complications and mechanical failures. The aim of our study was to describe the outcomes and postoperative complications of IM nailing of closed, long bone fractures in patients operated in a French front-line combat surgical unit (role 2+). Our hypothesis was that IM nailing is a reliable technique with low morbidity for the initial treatment of long bone fractures, even in precarious situations.

Material And Methods: This was a prospective, single-center, descriptive study of patients operated on between April 2016 and November 2017. All the patients with a closed femur or tibia fracture who were treated by IM nailing were eligible, no matter their time to surgery. The minimum follow-up was 6 months. The primary endpoint was the absence of infection-related complications and the secondary endpoint was fracture union.

Results: Fifty-eight patients were reviewed after an average follow-up of 4.7 months (range, 3-15 months). The mean patient age was 35.2 years (15-85 years) and the majority of patients were men (52 of 58). The fracture was in the femur in 74.1% (n=43) of cases and in the tibia in 25.9% (n=15) of cases. The time to surgery averaged 122.3 days (7-720 days) with a median of 60 days. In 74% of cases (n=43), fracture realignment required an open surgical approach. The postoperative course was considered normal in 96.6% of cases (n=51). No infections were reported as of the last follow-up visit. Union occurred in an average of 4 months in 70.7% of cases (n=41). There were three cases of nonunion after 6 months.

Discussion: Even in precarious situations, IM nailing is an effective, reliable method with a low complication risk and high union rate for the treatment of neglected long bone fractures. This surgical treatment is well suited to the poor sanitary conditions on the African continent.

Level Of Evidence: II, low-powered prospective study.
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http://dx.doi.org/10.1016/j.otsr.2018.10.017DOI Listing
February 2019

[Initial management of foot wounds].

Rev Infirm 2018 Oct;67(244):37-39

Service d'accueil des urgences, Hôpital d'instruction des armées Legouest, 27 rue de Plantières, 57000 Metz, France. Electronic address:

Foot wounds are frequent and not usually serious. The first caregiver to provide treatment must decide on the most appropriate action to take, sometimes in inadequate places. We present an analysis of the management of these traumas to highlight the key stages of the evaluation and initial treatment of the wound while placing the patient on a coherent and efficient clinical pathway.
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http://dx.doi.org/10.1016/j.revinf.2018.08.011DOI Listing
October 2018

Preparedness Evaluation of French Military Orthopedic Surgeons Before Deployment.

Mil Med 2019 01;184(1-2):e206-e212

Department of Orthopaedic, Traumatology and Reconstructive surgery, Percy Military Teaching Hospital, Clamart, France.

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http://dx.doi.org/10.1093/milmed/usy134DOI Listing
January 2019

[Role of the nurse in the case of complex hand wounds].

Soins 2017 Jun;62(816):13-16

Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France. Electronic address:

The initial assessment and care determine the quality of the secondary surgical treatment of complex hand wounds. The caregiver providing this initial care plays a critical role. The analysis of the management of these traumas in exceptional situations enables the key stages of the initial treatment to be identified: bleeding control, infection prevention and an accurate assessment of the injury. These measures thereby help to optimise the patient's transfer towards a specialised unit.
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http://dx.doi.org/10.1016/j.soin.2017.04.019DOI Listing
June 2017

Initial management of complex hand injuries in military or austere environments: how to defer and prepare for definitive repair?

Int Orthop 2017 09 10;41(9):1771-1775. Epub 2017 Apr 10.

Clinic of Traumatology and Orthopedics, Percy Military Hospital, Clamart, France.

Introduction: The damage control orthopedics (DCO) concept is a sequential surgical management strategy indicated when ideal primary treatment is not possible or suitable. DCO principles are routinely applied to hand traumas in wartime practice, but could also be useful in a civilian setting when immediate specialized management cannot be carried out.

Methods: The authors report three typical observations of soldiers treated for a complex hand trauma on the field by orthopedic surgeons from the French Military Health Service (FMHS). Application of the hand DCO concept is analyzed and discussed considering the literature and the FMHS experience.

Results: With regards to treating the hand, DCO necessitates a meticulous debridement with precise wound assessment, the frequent use of a primary definitive internal fixation by K-wires, and the possibility of a temporary coverage. These simple and fast procedures help avoid infection and prepare the hand for secondary repair.

Conclusion: Hand DCO can be applied by any surgeon in various situations: in association with polytrauma, complex injuries requiring multiple reconstructions, or delayed transfer to a specialized center.
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http://dx.doi.org/10.1007/s00264-017-3439-9DOI Listing
September 2017

Surgical support during the terrorist attacks in Paris, November 13, 2015: Experience at Bégin Military Teaching Hospital.

J Trauma Acute Care Surg 2017 06;82(6):1122-1128

From the Surgery Department (O.B., B.M., C.C., A.B., D.O., G.V.), Bégin Military Teaching Hospital, Saint Mandé, France.

Background: Recent conflicts have allowed the French Army Health Service to improve management quality for wartime-injured people during military operations. On November 13, 2015, it was in Paris that France was directly attacked and Bégin Military Teaching Hospital, like several hospitals in Paris, had to face a large number of gunshot victims. Thanks to our operational experience, injured people hospitalized in military hospitals benefited from a management based on triage and damage control (DC) principles.

Methods: Forty-five patients were taken care of in our hospital with an average age of 32 years. During triage, eight patients were categorized T1 (with four extreme emergencies) and 10 were classified T2 and 27 as T3. Twenty-two patients underwent emergency surgery, 15 for soft tissue lesions of limbs, 8 for ballistic fractures (one of which was a cervical wound), and 5 for abdominal wounds. Two patients classified T1 died early.

Results: In total, more than 50 operations were performed including iterative debridements, bone fixation, three amputations, and two flaps. After 9 months, all of the patients had healed. One woman with limb stiffness required an arthrolysis.

Conclusion: This event showed that terrorist attacks and mass casualties with war wounds can occur in France. Acquired experience regarding war wounds by the French Army Health Service is precious. Everyone must understand the importance of triage and the principles of damage control. Every hospital must be ready to face this type of massive influx of injured people (white plan).

Level Of Evidence: Epidemiological study, level V.
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http://dx.doi.org/10.1097/TA.0000000000001461DOI Listing
June 2017

Endovascular treatment of brachiocephalic artery war-related injury.

Acta Chir Belg 2017 Aug 9;117(4):256-259. Epub 2016 Nov 9.

a Vascular Surgery Department , HIA Percy , Clamart , France.

Introduction: Injuries to the innominate artery are rare, but potentially fatal. Early diagnosis and treatment may avoid life-threatening complications. Endovascular surgery often has lower morbidity and mortality rates than conventional surgery.

Clinical Case: We reported the case of a 28-year-old Yemenite soldier who presented with a shrapnel-related chest puncture wound following a shell explosion in Djibouti causing a 5 mm pseudoaneurysm of the innominate artery without associated complications. After medical repatriation to France, the pseudoaneurysm was treated by endovascular exclusion using a covered stent.

Discussion: Endovascular treatment of supra-aortic trunk lesions is an alternative to surgery with fewer postoperative complications, but long-term follow-up is lacking.
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http://dx.doi.org/10.1080/00015458.2016.1253236DOI Listing
August 2017

Usefulness of 18F-fluorodeoxyglucose positron emission tomography scan in the assessment of periprosthetic collections: report of 2 cases with opposite management.

Ann Vasc Surg 2014 Apr 8;28(3):738.e1-6. Epub 2013 Nov 8.

Department of Vascular Surgery, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.

Vascular prosthetic infection is a rare but serious complication of vascular surgery that requires rapid diagnosis and treatment. It is associated with high rates of amputation and death. The diagnosis is difficult when faced with a chronic nonspecific clinical presentation. We report 2 cases showing the diagnostic usefulness of positron emission tomography (PET). In 1 case, PET excluded with certainty the septic character of a periprosthetic collection fistulized with the skin by showing a periprosthetic fixation insufficient to diagnose an infection. In the other case, it confirmed the prosthetic infection in association with an evocative clinical picture by revealing a pathologic periprosthetic hyperfixation. PET scan therefore drew aside the diagnosis of prosthetic infection faced with a mild clinical and paraclinical presentation in the first case, and made it possible to pose it with certainty in the second case. This examination made it possible to save valuable time in 1 case and to elucidate the periprosthetic collection in the other case. Therefore, the rule of surgical explantation of any prosthesis with flow or periprosthetic collection is no more univocal.
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http://dx.doi.org/10.1016/j.avsg.2013.07.030DOI Listing
April 2014