We describe the preliminary results of a novel two-stage reconstruction technique for extended femoral bone defects using an allograft in accordance with the Capanna technique with an embedded vascularized fibula graft in an induced membrane according to the Masquelet technique. We performed what we refer to as “Capasquelet” surgery in femoral diaphyseal bone loss of at least 10 cm. Four patients were operated on using this technique: two tumors and two traumatic bone defects in a septic context with a minimum follow up of one year. Consolidation on both sides, when achieved, occurred at 5.5 months (4–7), with full weight-bearing at 11 weeks (8–12). The functional scores were satisfactory with an EQ5D of 63.3 (45–75). The time to bone union and early weight-bearing with this combined technique are promising compared to the literature. The osteoinductive role of the induced membrane could play a positive role in the evolution of the graft. Longer follow up and a larger cohort are needed to better assess the implications. Nonetheless, this two-stage technique appears to have ample promise, especially in a septic context or in adjuvant radiotherapy in an oncological context.

Chest masculinization is currently the most commonly performed gender-affirming surgery. It is often preceded by testosterone replacement therapy, whose duration is not agreed upon before surgery. Our study evaluates the postoperative satisfaction of transgender men who have undergone chest masculinization surgery according to their preoperative hormonal treatment duration. We conducted a single-center prospective study conducted from 2021 to 2022. All transgender men older than 18 years who had chest masculinization surgery were included. Demographic data, medical history, operative data, and duration of preoperative hormone therapy were collected. Participants completed the BREAST-Q© and BODY-Q© questionnaires pre- and postoperatively. Forty-six patients were included, with a median age of 21 years (18–45 years). The median preoperative testosterone duration was 596 days (186–4479 days). A significant improvement was found in BREAST-Q© (psychosocial, sexual and physical well-being; satisfaction with chest) and BODY-Q© (satisfaction with chest and nipples) parameters (p < 0.01). There was no significant correlation between preoperative hormone therapy time and chest satisfaction of BREAST-Q© (ρ = 0.069; R2 = 0.002; p = 0.647) and BODY-Q© (ρ = –0.114; R2 = 0.007; p = 0.450). All patients in our study were exposed to exogenous testosterone for at least six months. Our study suggests that satisfaction remains unchanged with a longer duration of usage, indicating that an extended period of hormone impregnation may not be necessary before performing chest masculinization surgery in transgender men. Furthermore, the findings confirm a significantly high post-operative satisfaction rate among participants, emphasizing the positive impact of this type of surgery.

Nerve wrapping provides protection, reduces adhesions, and supports regeneration, with proven benefits in median and ulnar neuropathies. Brachial plexus neuropathies—arising from neurogenic thoracic outlet syndrome (NTOS), radiation-induced brachial plexopathy (RIBP), or trauma—pose distinct challenges, and indications for wrapping remain poorly defined. We conducted a systematic review of brachial plexus wrapping techniques to clarify approaches and outcomes. PubMed, Scopus, Cochrane Library, and ProQuest were searched following PRISMA guidelines; the protocol was registered on PROSPERO. Risk of bias was assessed with the MINORS tool. Extracted data included patient characteristics, surgical techniques, functional outcomes, complications, and recurrences. Seventeen studies involving 645 patients (mean age 43.8 years; M/F 1/3.92) were included. The main indications were NTOS (77.1 %) and RIBP (22.6 %). Eleven wrapping techniques were identified: eight different flaps (n = 214) from omental, muscular, or adipofascial origins, and three medical devices (n = 426). NTOS was mainly treated with synthetic membranes, and RIBP with flaps. Pain reduction was reported in 91.9 % of cases, with complete relief in 62.8 %. For RIBP, motor improvement (52.5 %) and sensory improvement (50 %) were observed, while QuickDASH scores for NTOS improved by a mean of 23.3 points. Comparative studies (n = 4) suggest wrapping may outperform neurolysis alone in RIBP. Brachial plexus wrapping may improve pain and function in selected patients, but current evidence is heterogeneous, retrospective, and at high risk of bias. Standardized, prospective controlled studies are required to determine its role relative to isolated neurolysis. Level of evidence: III