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HÔPITAL LAPEYRONIE, MONTPELLIER, FRANCE
Professor Luc Téot, Plastic and Reconstructive Surgery

The Montpellier University Hospital has a long history in wound healing. One of the oldest Medical Schools in the western world, Montpellier presents a peculiar medical past coming from the time when this young city, founded in 900, belonged to the Kingdom of Majorca, when Jaime I was under the influence of the Arabs. Avicenne was at this time one of the conceptors of wound infection treatment. The second chance of our city was given by the French King, Saint-Louis, who decided to send soldiers to free Jerusalem. This decision rendered Montpellier a crucial point of emergency. Wounded and ill people were coming in and out of the French Territory by a gateway called Aigues-Mortes, located 25 km from Montpellier - a harbour in the Rhône river delta, now covered with sand, in an area now known as the Camargue.

Several famous surgeons and medical doctors, such as Rabelias, Guy de Chauliac, Lapeyronie and Arnaud de Villeneave, came from Montpellier to become doctors at the courts of the Kings of France.

Our aim is now to keep the knowledge accumulated from this prestigious past, but mainly to develop a modern programme in wound healing. The wound healing commission in our institution was developed in 1992, when American and British colleagues convinced us to develop the moist wound healing concept. Nurses and doctors shared the responsibility to develop protocols, and the rate of pressure sores decreased from a 14% prevalence rate to a 5.9% rate in a period of ten years. Education was developed by nurses and doctors, offering a double level formation: Level 1 for occasional practitioners in wound healing; and a University Diploma (Level 2, existing since 1997, co-ordinated by Olivier Dereure and Luc Téot) where more than 100 experts can be trained each year. All these efforts were primed in 1999, when our institution won a national prize of transversality, given by the First Lady in the Palais de l'Elysée.

From a practical point of view, the wound healing programme is divided into several components:

  • The Nursing Directory is driving the practical education of prevention and basic care of pressure sores, diabetic foot ulcers, leg ulcers and acute wounds.
  • A multidisciplinary medical team formed by plastic surgeons, dermatologists, angiologists and endocrinologists assists them and collaborates to establish a network inside the hospital and outside, towards the surrounding hospitals, the private practitioners and the communities and participate in the medical education program.
  • A wound healing research unit was developed in the Dermatology INSERM unit (medical research units) lead by Professor Jean Jacques Guilhou and Doctor Jean-Pierre Moles, where several research works could be started on the wound fluid growth factors evaluation.
  • Contacts with the Science University were particularly developed with Professor Jean-Louis Montero, Professor of Chemistry and Vice Dean of the University on a programme concerning the use of oyster mother of pearl as a bone substitute and with the Robotics Lab (Professor Etienne Dombres), where a robot able to harvest partial thickness skin grafts was developed in partnership and is now a reality coming on the market.
  • Chronic wounds are taken in charge by referents, two nurses and one doctor for each 600 bed hospitals (five hospitals with a total of 3000 beds) who refer to the surgical team when necessary. Concerning burns, a ten bed unit has been opened since 1986, where patients are treated under the supervision of intensive care specialists. This unit offers a complete treatment, from the emergency situation to the sequellae problems management.
  • The plastic surgery activity, hosted in the maxillo-facial unit, works in transversality with the medical and surgical teams, a patient being transferred to the unit where the patient is hospitalised for debridement or coverage, then coming back to the original unit as soon as possible.

The Montpellier University Hospital actively participates in the organisation of the national Conference des Plaies et Cicatrisations, where practitioners coming from all fields concerned with wound healing problems have attended every year in January since 1997.

Luc Téot
Montpellier

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