Use of a new, flexible lipidocolloid dressing on acute and chronic wounds: results of a clinical study.

OBJECTIVE: To document the performance (efficacy, tolerability and acceptability) of Urgotul Flex, a new, more flexible version of the lipidocolloid dressing Urgotul, in the management of acute and chronic wounds. Efficacy was defined as the reduction in ulcer surface area after 4 weeks of treatment. METHOD: This open, non-comparative, multicentre clinical trial recruited patients from 11 centres, which included surgical, burns and rehabilitation units and paediatric, geriatric and dermatology wards. Inclusion criteria were non-infected wounds of any aetiology that were <120cm2 in size. Ulcer surface area was assessed by tracing and planimetry. Acceptability parameters were: ease of dressing application; pain at dressing change; dressing adherence to wound bed and bleeding at removal; maceration of surrounding skin; these were all assessed qualitatively. Patients were followed up for a maximum of 4 weeks, or until they healed if this occurred first. Efficacy and tolerability were assessed by the physicians on a weekly basis, and acceptability by the nursing staff at each dressing change. All of the physicians/nurses had previously participated in clinical evaluations of Urgotul using the same outcomes and assessments, and so performed a retrospective assessment of the two dressings. RESULTS: Forty-four patients from 11 investigating centres were included in the study. The mean baseline surface area at was 21cm2 and 6cm2 for the acute and chronic wounds respectively. Twenty wounds (17 acute wounds and three chronic wounds) healed. Of the remainder, the mean surface area reduction was 78% and 42% for the acute and chronic wounds respectively at the end of the 4-week treatment period. Only two local adverse events were reported, but these were not considered to be dressing related. Based on the 345 documented dressing changes, conformability of the new dressing was considered to be superior to that of Urgotul, particularly when used on acute wounds. CONCLUSION: These findings show that the efficacy and tolerability of Urgotul Flex is similar to that reported in previous observational studies on Urgotul. However, results show it is more flexible and thus more conformable, particularly when used on wounds in awkward locations, including paediatric wounds and hand surgery. CONFLICT OF INTEREST: This evaluation was sponsored by Laboratoires URGO, Chenôve, France.

Using a new lipidocolloid dressing in paediatric wounds: results of French and German clinical studies.

OBJECTIVE: To evaluate the efficacy, tolerance and acceptability of a lipidocolloid dressing, Urgotul (Laboratoires Urgo), in the local treatment of acute and chronic paediatric wounds. METHOD: Two non-comparative multicentre prospective clinical studies were conducted using the same protocol in France and Germany. A total of 100 patients were recruited from 16 centres (11 in France and five in Germany), and followed up for four weeks. Seventy wounds (55 burns and 15 other wounds) from France and 30 from Germany (22 burns and eight other wounds) were evaluated by nursing staff at every dressing change and by the medical investigator on a weekly basis. RESULTS: In the French study population, 86% of the burns (superficial and deep partial-thickness) and 53% of the other wounds healed completely within the four weeks. Figures for the German study population were 100% and 88% respectively. Pain was evaluated using pain scales adapted to the patient's age (objective pain scale, faces scale for pain and a visual analogue scale) at each dressing change. Dressing removal was non-traumatic, inducing very limited pain. Minor local adverse events were reported in four children. CONCLUSION: Urgotul is not only efficacious, but also well-tolerated and accepted by children with acute and chronic wounds. The dressing, therefore, might be an appropriate and highly promising alternative to conventional dressings.

[Use of skin expansion in resurfacing defective amputation stumps of the lower limbs. 6 case reports]. / Utilisation de l'expansion cutanée dans le resurfaçage des moignons d'amputation de jambe défectueux. A propos de 6 cas.

Better procedures and materials have enabled us to improve the results of skin expansion under knee level and extend its indications. We have used such procedures to cover defective amputation stumps in the lower extremity. When the local conditions are suitable, skin expansion permits the use of healthy skin from the lateral sides of the stump to provide coverage for the ulcerated areas, thus fulfilling the main goals which are to keep the bone shaft as long as possible and cover the stump with sensitive skin, so that a prosthesis can be fitted. In two cases, we also performed skin expansion at a distance to reduce the residual scar at the donor site (expanded flap from the other leg, expanded full-thickness skin graft) when the amount of healthy skin available around the stump was insufficient; the functional results were satisfactory. Skin expansion has become a choice strategy for this type of indication, but it must be performed perfectly to avoid complications or failures (our two first cases). It is important to take precautions at various stages of the operation which must be carefully staged.

[Prospective study of 100 cases of breast hypertrophy]. / Etude prospective à propos de 100 cas d'hypertrophie mammaire.

The authors performed a prospective study of 100 consecutive cases of mammary hypertrophy. Sixty were treated by McKissock's technique and forty by Thorek's technique. The patients were reviewed at the second and sixth postoperative months. A general study of the population was performed to specific their demand, which was functional in 90% of cases, and the various symptoms were quantified. 74% of cases presented with psychological problems and a desire for aesthetic improvement was expressed by 67% of cases. Postoperatively, a functional improvement was obtained in 99% of cases, while psychological disorders resolved in 100% of cases. The satisfaction rate was very high: 79% of patients were very satisfied and 20% were satisfied. Some defects observed by the patients or surgical team are analysed. The complications observed, always minor, are reported. Breast reduction provides an unquestionable benefit for patients with mammary hypertrophy. Two simple and perfectly defined techniques were used to treat all these cases with a maximal satisfaction rate and a minimal complication rate.

[Malignant melanoma in children. Apropos of 6 cases]. / Le mélanome malin de l'enfant. A propos de six cas.

Six cases of malignant melanoma were observed in children aged 5-14 years, over a 14-year period: both sexes were equally affected. In three cases, the melanoma was a primary tumor, which indicates that this diagnosis should always be born in mind in children and any suspicious lesion should be biopsied and removed. Three cases had a family history: dysplastic naevus in two cases and malignant melanoma in one case, which confirms the increased risk in some families. Histologically, nodular forms were more frequent than those which spread superficially and the tumors were quite thick when diagnosed (mean thickness: 3.9 mm). Treatment includes wide excision and coverage with skin grafts associated with immuno or chemotherapy in some cases. Mean follow-up was 38 months and no death occurred during this period.

[Coverage flaps for loss of substance of the scalp. Our experiences apropos of 42 cases]. / Les lambeaux de couverture des pertes de substance du cuir chevelu. Notre expérience à propos de 42 cas.

We report our experience with 42 coverage flaps for tissue loss involving the scalp. Malignant tumors of the scalp were the major cause of tissue loss. Repair modalites and outcome are reported. This series included 23 local flaps, one pediculated regional flap, and 18 free flaps associated with three cranioplasties and four dura mater plasties due to invasion of the subjacent tissues. We discuss therapeutic indications and insist on selection criteria which depend on etiology (localization, form depth), local factors (integrity of the pericranium and subjacent structures) and general factors (age, sex, physical and psychological status, socioprofessional context, patient expectations). In all cases, we opted for tissue repair which offers greater safety with minimum function and esthetic morbidity.

[History of the techniques of obtaining skin]. / Historique des techniques de gain de peau.

The history of skin gaining techniques, concerns suture, skin extension and skin expansion. Although, for a very long time, suture and skin extension were intimately related and constitute the basis for current techniques, it was only from the second part of the 20th century that skin expansion was developed and that skin extension was submitted to specific studies.

[Repair of skin defects by skin extension procedures]. / La réparation des pertes de substance cutanée par les procédés d'extension cutanée.

The repair of defects by skin extension involves various procedures which are thoroughly described by the author. Skin extension is an original concept reflecting the viscoelastic properties of the skin and histological changes. It is based on 3 phenomena: "mechanical creep", "stress relaxation" and mobility of the skin. Although the various skin extension procedures present many advantages concerning the application and removal of the device, the conduct and monitoring of treatment as well as closure of the defect, its disadvantages must not be ignored. They are related to the material and to local conditions. The indications for skin extension are fairly wide. However, its ideal indication consists of closure of skin defects with loss of skin capital.

[Vacuum assisted closure. Wound healing by negative pressure]. / Le vacuum assisted closure. La cicatrisation par pression d'air négative.

"Vacuum Assisted Closure" (VAC) is a noninvasive negative pressure healing process indicated in the treatment of chronic wounds associated with unfavourable local or systemic factors. It is indicated for the treatment of traumatic and/or surgical skin defects in order to accelerate the healing process. VAC is based on a simple technology of controlled depression of the lesion which healing process. It exerts a mechanical force on the tissues and attracts the wound edges centripetally. It induces an increased peripheral blood flow, improved local oxygenation and promotes angiogenesis and proliferation of good quality granulation tissue. Wound healing in a humid medium is complete or may require secondary surgical management (skin graft, flaps). The preferential indications for Vacuum Assisted Closure include pressure sores, leg ulcer, wounds with skin defects, burns, complications of surgical wounds and delayed healing.

[Kidney traumatism in general surgery (65 cases)]. / Traumatismes du rein en chirurgie générale (65 cas).

From September 1989 to September 1994, 65 patients, 15 females and 50 males, with a mean age of 32 +/- 14 years were admitted in the emergency unit for renal trauma. In 38.5% of cases multiple trauma was present. Lesional mechanism was most frequently contusions (49.2%) and deceleration injuries (43.1%). Gross hematuria or microscopic hematuria were presents in 72.3% of cases. The sensibility of systematic abdominal echography was 100% in case of perirenal hematoma and 65% in case of parenchymatous lesions. Only 23 patients were operated (35.3%) because of low blood pressure. None secondary operation was necessary in abstention group. Global mortality was 7.7%. Postoperative morbidity was 20% and specific morbidity in abstention group was 10.7%.

[Post-traumatic liponecrosis. Apropos of a clinical case]. / La liponécrose post-traumatique. A propos d'un cas clinique.

Localized post-trauma liponecrosis, also called lipoatrophy, is a benign disease with no functional consequences but does cause important aesthetic problems. Diagnosis is often missed. Necrosis of the adipocytes occurs after direct trauma and absorption of the haematoma. It is important to search for favouring factors and order the necessary examinations. The therapeutic strategy is presented.

Advantages of early burn excision and grafting in the treatment of burn injuries of the anterior cervical region.

Excision and grafting in deep partial and full skin thickness burns of the anterior cervical region in a series of 40 patients treated between 1982 and 1992 is reported. The advantages of surgical management of deep burns in this region in a single staged operation have proved its efficacy compared to the severe sequelae which appear when the standard conservation treatment is used. A comparative study of two groups of patients treated either by early excision and grafting (n = 19/40), or by delayed excision and grafting (n = 21/40) demonstrated the advantages of elective early excision and grafting with respect to: length of hospital care, complications and their severity, and surgical repair.

[Contribution of abdominal plasty in the treatment of uncomplicated eventrations of the abdominal wall]. / Apport de la plastie abdominale dans le traitement des éventrations non compliquées de la paroi abdominale.

From 1987 to 1993, surgery combining two techniques was performed for 12 patients with uncomplicated abdominal wall eventration and excess subcutaneous adipose tissue. In order to meet both the functional and aesthetic needs of these patients, the operations required the co-operation between the plastic surgery and the abdominal surgery teams. Abdominal plasty was required to repair muscle and aponeurosis damage and remove abdominal dermolipodystropy with minimal, good quality scars. The early and late results were evaluated on the basis of several parameters including: global abdominal morphology, parietal containment, scar formation, complications, and the effect of treatment. Optimal results require a pluri-disciplinary approach.