Cavity wounds management: a multicentre pilot study.

The objective of this study was to assess acceptability (based on pain at removal), efficacy and tolerance of an absorbent and cohesive rope(UrgoClean Rope, Laboratoires Urgo) in the local management of deep cavity wounds. This study was a prospective, multicentre (13), non comparative clinical study. Patients presenting with an acute or chronic non-infected cavity wound were followed up for four weeks and assessed weekly with a physical examination, in addition to volumetric,planimetric and photographic evaluations. Pain at removal was the primary criterion, assessed on a Visual Analogic Scale. The percentage of the wound surface area reduction and volumetric reduction were considered as secondary efficacy criteria. Forty three patients were included in this study. After one week of treatment dressing removal was painless and continued to be so throughout the period of the trial(four weeks). Median surface area at baseline was 7.74 cm2 and was reduced by 54.5% at week 4 (relative area reduction). Median wound volumetric value was noted 12 ml at baseline and was reduced by 72.7% by the end of treatment. The cohesiveness of the new rope was considered very good by health professionals. No residue was observed on the wound bed during the dressing change with the new rope. There were no adverse events related to the tested rope, during this trial.Pain-free removal associated with good efficacy and tolerance were observed with this new cohesive rope in the healing process of deep cavity wounds and could represent a therapeutic alternative to the usual ropes used in such indications.

Evaluation of balloon catheter-guided intra-arterial thrombolysis for acute peripheral arterial occlusion.

BACKGROUND: The objective of this study was to evaluate the effectiveness of a new method of in situ thrombolysis using a porous balloon with low pressure compared with traditional in situ infusion of a fibrinolytic agent in the treatment of acute limb ischemia. METHODS: Between January 2010 and December 2011, 14 patients (mean age, 67.2 years; range, 40-89 years) treated for grade II acute lower limb ischemia for fewer than 14 days were included in the study. Thromboaspiration was tried initially in all the cases. All patients benefitted from a novel method of intra-arterial thrombolysis guided with a balloon catheter (ClearWay; Atrium Medical, Hudson, NH) and using the same agent thrombolytic (Actosolv). The total amount injected, the rate of morbidity associated with the thrombolytic treatment, and the duration of hospitalization in the continuous monitoring unit were analyzed. RESULTS: Recanalization was obtained in 92% of cases (13 of 14). The rate of morbidity related to the procedure was 7%. The amount of fibrinolytic agent necessary was relatively low (82,000 units/cm of occluded artery). The rate of limb salvage 6 months after recanalization was of 92%. The mean duration of stay in the continuous monitoring unit was 1.1 day. CONCLUSIONS: Intra-arterial thrombolysis using the ClearWay balloon catheter is an effective method in the treatment of acute peripheral arterial occlusion. In the event of embolic occlusion, mainly among very old patients, it could decrease the hemorrhagic risk. A randomized study in these high-risk patients could confirm these first results.

Acute peripheral arterial occlusion: prospective study evaluating intra-arterial thrombolysis with a micro-porous balloon catheter.

PURPOSE: To assess the efficacy of a new in situ thrombolysis method using a low-pressure micro-porous balloon catheter (MPBC) compared to a traditional in situ infusion (ISI) of a fibrinolytic agent in the treatment of acute limb ischemia. METHODS: Between January 2010 and December 2011, 21 patients (14 men; mean age 64.6 years, range 40-92) treated for acute lower limb ischemia were prospectively enrolled in the study. Seven patients underwent in situ thrombolysis using the ISI method and 14 patients the MPBC method to deliver urokinase. The total urokinase dose injected and the length of stay in an intermediate care unit were compared between the groups. RESULTS: Recanalization was successful in 90% of cases (6/7 patients in the ISI group; 13/14 patients in the MPBC group). The morbidity was 7% (1 pseudoaneurysm). The dose of urokinase needed was significantly lower (p<0.001) in the MPBC group (0.7±0.44 IU, range 0.15-1.6) vs. the ISI group (1.66±0.71 IU, range 0.2-2). The average length of stay in the intermediate care unit was significantly shorter in the MPBC group (1.2 vs. 3.9 days, p<0.002). The overall 6-month limb salvage rate after recanalization was 90% (83% for the ISI patients vs. 93% for the MPBC group). CONCLUSIONS: Intra-arterial thrombolysis using a balloon catheter is an effective method in the treatment of acute peripheral arterial occlusions. In the case of occlusion caused by embolism, primarily in very elderly patients, it may reduce the risk of hemorrhage. A randomized study on high-risk patients is needed to confirm these initial results.

Prevention of pulmonary complications after aortic surgery: evaluation of prophylactic noninvasive perioperative ventilation.

BACKGROUND: In 40% of the cases, pulmonary complications are encountered after aortic surgery in patients suffering from chronic obstructive broncho-pneumopathy (COBP). The factors aggravating the occurrence of these complications are cumulated tobacco addiction of ≥40 packets per year and surgery for aneurysm. The aim of our prospective study was to evaluate the effect of pre- and postoperative noninvasive ventilation (NIV) preparation on the respiratory function of patients presenting with high pulmonary risks. METHODS: Between September 2007 and May 2010, 30 patients were included in the present study. Inclusions criteria were male gender, patients suffering from COBP with tobacco addiction of ≥40 packets per year, and aortic surgery for aneurysm with or without occlusive lesions. In all, 14 of the 15 patients had effectively performed the preparation before and after surgery according to a fixed protocol (NIV group). We compared the respiratory rate complications and the mean hospital length of stay in intensive care with the non-NIV control group (15 patients). RESULTS: Mean age, severity of COBP according to the classification of the French Society for Pneumology, surgery duration, and blood losses were comparable between the two groups. Conversely, pulmonary complications were significantly lower in the NIV group (0/14 [0%] vs. 5/15 [33%], p = 0.004). Hospital length of stay in intensive care was shorter in the NIV group (2.5 vs. 6.5 days, p < 0.001). CONCLUSION: Preliminary results are encouraging, in favor of pulmonary preparation before aortic surgery with NIV at home, and carried on postoperatively in hospital for patients with COBP. These results prompt us to propose a multicenter study to validate these first observations.

Intercostal-subcostal combined complete port-accessed video-assisted lobectomy.

Video-assisted lobectomy procedures include a broad spectrum of operative techniques that range from complete thoracoscopic surgery to minithoracotomy with a thoracoscope serving only as a light source. We describe a modified method for thoracoscopic approach for lobectomy with thoracic muscle sparing based on a combined complete port-accessed technique with a subcostal incision. We have successfully used this technique for lobectomies in stage I lung tumors. Intercostal muscles and nerve injury preservation allied to fast track rehabilitation perioperative care allowed rapid postoperative recovery.