Management of diabetic foot ulcers with a TLC-NOSF wound dressing.

OBJECTIVE: To evaluate the efficacy, tolerance and acceptability of UrgoStart Contact (Laboratoires Urgo), a new wound dressing impregnated with NOSF, as an MMP regulator in the management of neuropathic diabetic foot ulcers. METHOD: A multicentre, pilot, prospective, non-controlled open-label clinical trial. Adult patients with type 1 or 2 diabetes mellitus, who had a grade 1A (Texas classification), uninfected, neuropathic foot ulcer, 1-15cm2 in size and of 1-20 months' duration (mean 6.7 ± 5.2 months) were included in the study. The primary endpoint was the relative reduction of the wound surface area (%) at the end of the study. Secondary endpoints included rate of complete healing, and tolerability and acceptability of the dressing. The wound dressing was changed regularly at the investigator's discretion, in accordance with the wound status and exudate level. Patients were followed up every 2 weeks for a 12-week period. At each visit, patients underwent clinical assessments, and ulcer surface area was measured by planimetry and photographs. RESULTS: Thirty-four diabetic patients with a neuropathic foot ulcer were included but only 33 cases were analysed, as data were completely lost for one patient. At baseline, mean surface area was 2.7±2.4cm2. At the 12-week follow-up, the median surface area reduction was 82.7% (mean reduction 62.7 ± 49.9%) and in 10 of the 33 analysed patients (30%) the wound was healed. Only two of the seven documented local adverse events were deemed to be dressing related. According to the nursing staff, acceptability was considered very satisfactory, particularly in term of conformability and ease of use. CONCLUSION: This pilot study indicates that use of the new UrgoStart Contact dressing, combined with offloading and debridement,may help promote the healing process of the neuropathic diabetic foot ulcers, and was well tolerated and accepted.

Phase 2 study of a new Hydrofiber dressing for superficial chronic or acute wounds.

OBJECTIVE: To evaluate the safety and performance of MedicelTulle Dressing (MTD) in subjects with chronic or acute wounds left to heal by secondary intention. METHOD: This 28-day, multi-centre, single-arm clinical study was conducted at seven sites in France. Thirty patients with a chronic (n = 20) or acute wound (n = 10) were treated with MTD and gauze as a secondary dressing. Study treatment lasted 28 days or until healing. RESULTS: Mean baseline wound area was 14.8cm2. There were 103 clinic dressing changes and 220 home dressing changes. Seven adverse events were reported in five subjects, including one treatment-related adverse event of dry scab. No adherence was reported for 66% of clinic dressing changes and 53% of home dressing changes. No trauma was reported for 96% of clinic dressing changes. Mean reduction in wound size was 7.0cm2. CONCLUSION: In this study, MTD demonstrated good safety results. Additional study is warranted to confirm the clinical utility of MTD in the management of chronic or acute wounds left to heal by secondary intention.

[Rhizarthrosis and orthotic treatment. Review of literature]. / Rhizarthrose et orthèse.Revue de la littérature.

OBJECTIVES: Trapeziometacarpal arthritis or rhizarthrosis is extremely frequent. Numerous treatments are available including drugs, physiotherapy, use of orthotic devices, surgery, etc. Few of these methods have been really evaluated. We propose a critical review of the literature on orthotic treatment in rhizarthrosis. MATERIALS AND METHODS: Review of the results of hand splint used in rhizarthrosis from eight studies published over the last ten years. RESULTS: Resting hand splints offer lasting and significant pain relief with a satisfactory compliance. They should be applied early in treatment and evaluated with regular follow-up. The drop-out rate is about 10%. Working hand splints, either alone or associated with a resting splint are also efficient. These is no modification in either the force or the ranges of motion. The functional benefit is satisfactory if the follow-up allows some tolerance and thus an optimal compliance. CONCLUSION: The major interest of the use of splinting is analgesia. The pain releif obtained with splint is similar when used alone or with a working hand splint. Working hand splint can improve hand function during vocational and avocational activities.

Restoration of sensation over the contact surfaces of the thumb-index pinch grip using the terminal branches of the superficial branch of the radial nerve.

In huge median nerve losses and in some brachial plexus lesions, absence of sensation over the pulps of the index finger and the thumb preclude their use without visual control. Currently, end-to-side anastomosis is a new option available (when the ulnar nerve is intact) but we have reviewed the results of 7 cases of nerve anastomosis between the sensory branches of the radial nerve and the collateral nerves of the thumb (ulnar) and index finger (radial). Palmar translocation of the donor nerve, as classically performed, was used in two cases and the technique was subsequently modified to provide a better nerve suture by dorsal transfer of the collateral nerves of the thumb and index. Two sequellae of brachial plexus lesions and 5 cases of extensive defects of the median nerve were reviewed at a mean follow up of 5 years. With the classical technique the two point discrimination was 15 mm in one case and more in the other; with the modified technique, 4 patients achieved a thumb discriminaTion of 9 mm, 12 mm (2 cases) and 13 mm.

[Results of orthopedic and surgical treatment of mallet finger by subcutaneous rupture of the extensor tendon. Apropos of a series of 216 cases]. / Les résultats du traitement orthopédique et chirurgical du doigt en maillet par rupture sous-cutanée du tendon extenseur. A propos d'une série de 216 cas.

PURPOSE OF THE STUDY: To assess the late results of orthopaedic and surgical treatment for mallet finger, two groups of patients were reviewed in a retrospective study. MATERIAL AND METHODS: 156 fingers (Group I) had conservative treatment and 60 fingers (Group II) some form of surgical treatment. RESULTS: In Group I, a dorsal custom-made perforated splint maintained the distal interphalangeal joint (DIP) in extension for an average of 54 days (st13). The mean delay of presentation was 22 days (st36). Initial lack of extension was 35 degrees (st13). After an average follow-up of 154 days (st240), the lack of extension was only 7 degrees with an active range of flexion of 61 degrees (st11). 68 of these patients were reviewed for a long-term assessment (61 months). At this time, lack of extension and range of flexion were not different (respectively 5 degrees- st10 and 61 degrees- st16). In Group II, 45 per cent of patients had initially some form of orthopaedic treatment. Delay between injury and consultation was 118 days (st250). Review with a mean follow-up of 5.6 years demonstrated a lack of extension and a DIP joint flexion of 12 degrees and 53 degrees for tenodermodesis (14 cases), 2 degrees and 59 degrees for the Thompson and Littler procedures (14 cases), 1 degree and 55 degrees for the Fowler tenotomy (10 cases). DISCUSSION AND CONCLUSION: Orthopaedic treatment gave good functional results even in cases with delay of presentation. Surgery is only indicated in failure of conservative treatment. In absence of swan-neck deformity, tenodermodesis is a simple and effective technique. When a swan-neck is present, if the DIP deformity is corrected by PIP stabilization, the Fowler tenotomy is used. Otherwise, the Thompson and Littler operation allows to fully correct the deformity.

The results of conservative management of trigger finger. A series of 169 patients.

The authors present the preliminary results of a series of 230 trigger fingers in 169 patients managed conservatively by injection of 1 ml of hydrocortisone into the flexor sheath as described by Curtis. 'Good' results were obtained after a single infiltration in 73% cases, after two infiltrations in 81.6% cases and in 83% cases after three infiltrations. Factors have been studied in order to identify variables with prognostic significance. The outcome was not influenced by the severity of symptoms, by the association with other disease, by sex or by the site of pathology. Outcome was affected by the duration of symptoms. Duration exceeding one year indicates surgical release as does failure of conservative treatment.

Indications and results of skin flaps in painful digital neuroma.

Of the many procedures for treating painful neuromas, resection and proximal translocation are the most usual techniques, but these can decrease distal sensibility increasing deafferentation pain. In cases of intricate pain (nociception plus deafferentation), certain types of flaps allow the treatment of both components of the pain. We have used 30 such flaps in 28 patients: local flaps (exchange, advancement or lasso island flaps) and distant flaps (free "custom-made" toe flaps). The results of the different techniques provides 86.6% excellent or good results.

[Local intravenous treatment of algodystrophy of the hand: buflomedil versus guanethidine, long term follow-up]. / Traitements locaux intra-veineux des algodystrophies de la main: buflomédil versus guanéthidine, suivi à long terme.

This report compares the results obtained after treatment of reflex sympathetic dystrophies (algodystrophies) of the hand by pharmacological segmental blocks with buflomedil (51 cases) versus guanethidine (30 cases). The results were similar for all the different stages of algodystrophies treated: 65% satisfactory to excellent results with buflomedil, versus 63% with guanethidine. The sooner the algodystrophy is treated after its onset, the better the results. On TPBS, when the technique is effective, both hemovelocity and blood pool return to normal, along with the improvement in the patient's condition. Early and delayed bone fixations evolve independently of the treatment. These techniques should always be associated with active, mild physiotherapy, and in some cases with dynamic splints in order to prevent the development of functional sequelae in the form or capsulo-aponeurotic retraction.

[Role of orthosis in the treatment of stiffness of the hand]. / Le rôle de l'orthèse dans le traitement des raideurs de la main.

The statistical analysis of results obtained with splinting treatment of finger and hand stiffness, and derived from a series of 635 motion range measurements taken on 249 hand joints, provided us with sufficient data to identify the various factors likely to have an impact on the therapeutic outcome. A mean increase of 25.8% in the range of movements is enough to justify the use of orthosis, although this figure actually varies substantially with the patient's age, the duration of the stiffness, the latter's degree and origin, the joint involved, and the duration of the orthotic treatment. An analysis of the time factor enabled us to establish the date beyond which changes for recovery are quite limited, whereby allowing to schedule surgical mobilization.

[A multidisciplinary approach to algodystrophy of the hand]. / L'approche pluridisciplinaire de l'algodystrophie de la main.

A multidisciplinary approach for the management of reflex sympathetic dystrophy at SOS Main of Strasbourg has been progressively adopted due to the severe functional sequelae of this disease. The TC99 bone scan in three phases has allowed us after a one week duration of the symptoms to make an early diagnosis and to start dynamic splinting in flexion. Our study compares two groups of patients, one with an early treatment and the other with delayed treatment. It shows a correlation between the stiffness of the affected hand and the isotopic findings. The benefit from an early dynamic splinting in flexion as evidenced by a clinical improvement is corroborated by the bone scan.