ABSTRACT
Objective To compare the efficacy of the reforming endoscopic minimally invasive releasing(REMIR) with open procedure for treatment of carpal tunnel syndrome.Methods Senventy patients with unilateral carpal tunnel syndrome were randomly divided into REMIR group and open procedure group,with 35 cases in each group.Kelly's standard,two-point discrimination,operation time and complication occurrence were compared between the two groups.Results All patients were followed-up for 12 months.There was no significant difference in the therapeutic results and in the improvement of two-point discrimination between the two groups (P ＞ 0.05 ).The operation time of REMIR group was significantly shorter than the open procedure group ([ 10.03 ± 1.84] min vs [37.63 ±7.18]min,t =22.210,P ＜0.001 ).And there was no cases with scar tenderness in REMIR group while there was 7 cases in open procedure group.Conclusion Compared with the open procedure,the REMIR method has the same clinical efficacy while with the advantages of causing smaller skin scar and being less time consuming.
ABSTRACT
BACKGROUND: The wound eschars are often excised from the large wounds of deep second degree bum, but the tangential excision may remove excessive tissues of the epithelial regeneration in residual skin wounds.OBJECTIVE: To investigate the therapeutic effect of electro-driven abrasion treatment in deep second-degree bum wounds on keratin 19 expression, the marker of the epithelial stem cell in residual skin wounds.DESIGN, TIME AND SETTING: Randomized controlled trials were performed from October 2002 to January 2004 in the Guangxi Medical University.MATERIALS: Forty patients suffered thermal (heat or fire) burns were recruited from Department of Burn and Plastic Surgery,aged 18-37 years. The average burn size approaches 15% -45% total body surface area, while deep second-degree burn size was 15%-30%. The patients were divided randomly into two groups, abrasion treatment group (n=20) and tangential excision treatment group (n=20).METHODS: Abrasion treatment group: The wound eschers were removed from superficially to deeply by the electro-driven abrasion instrument, until the wound beds were red hyperaemia or bead bleeding. Tangential excision treatment group: The wound eschars were excised by the skin graft knife, until the wound beds were chalkiness and wet. There were not brown tissue and reticular vascular thrombi. The wound beds were bead bleeding after the hemostasia strap was relaxed. At times the operations were so excessively deep as that fat tissues on the wound beds were revealed. The wound beds in two groups were covered by porcine skin postoperation.MAIN OUTCOME MEASURES: Tissue specimens were taken from the wounds to detect keratin 19 expression in regenerative tissues by using S-P immunohistochemical method before and after operation. Assisted by optical microscope (100x), five view areas were randomly selected to count cells. The healing time of the wounds in two groups was recorded, the granulation wounds that failed to heal required secondary operation.RESULTS: Electro-driven abrasion treatment could preserve more skin attachment, such as dermis, hair foltides, sebaceous glands,and sweat glands. Tangential excision treatment could preserve less skin attachment, such as lamina network tissue residuals, some hair follicles and sweat glands. At times the fat tissues on the wound beds were revealed, rather than dermis. Results of cell counts expression, keratin 19 expression in the residual skin wounds could be seen in both two groups before and after operations. No significant difference was found in the keratin 19 expression before and after abrasion treatment (P > 0.05), while keratin 19 expression counts in the tangential excision treatment group were decreased compared with before operation (P < 0.05). The healing in the abrasion treatment group occurred eadier than in the tangential excision treatment (P < 0.05). There were 2 wounds in the abrasion treatment group and 8 wounds in the tangential excision treatment group requiring secondary operation (P < 0.05).CONCLUSION: Applying electro-ddven abrasion treatment to heal deep second-degree burn wounds is efficient and induces less damages to tissues. Compared with tangential excision treatment, it can preserve more regenerated skin tissues, and is helpful to repair of epithelial stem cells through the regeneration and to shorten the healing time of wounds.