LA MALADIE DE DUPUYTREN TRAITEE PAR DERMOFASCIECTOMIE (A PROPOS DE 54 CAS REVUS)

BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Articular reconstructions by a costochondral grafting (or osteochondral costal grafting)]

International audienceWe describe a novel technique of costochondral autografting for the treatment of trapeziometacarpal arthritis, radioscaphoid osteoarthritis, malunion of the distal end of the radius, and osteoarticular loss of the MP joints of long fingers. The costal graft harvest technique is always the same. A 5-cm horizontal incision is made over the 9th rib, and the rib is exposed at the osteocartilaginous junction. Cartilaginous grafts are harvested with a scalpel, and osteocartilaginous grafts with a saw. Since 1992, 116 patients with trapezio-metacarpal arthritis have been treated by partial trapeziectomy and autologous rib cartilage grafting. One hundred patients were reviewed with an average follow-up of 5.6 years. The results were better than those of trapeziectomy with tendon interposition or ligamentous reconstruction, owing to good stability of the thumb ray height. For the treatment of radioscaphoid osteoarthritis following scaphoid non union or chronic scapholunate instability, partial carpal arthrodesis and resection of the first row are the classical techniques. As an alternative to these procedures, 18 patients were treated by resection of the proximal portion of the scaphoid and insertion of an osteochondral costal autograft. Mean follow-up is 4.1 years. The results are excellent or good in 15 cases, fair in 2 cases, and poor in 1 case (luxation of the graft). Four patients with articular malunion of the distal radius received an osteocartilaginous costal graft to reconstruct the articular surface of the radius while avoiding partial or total arthrodesis of the wrist. Four patients with segmental osteoarticular loss of the longfingers were treated with the same technique, thereby avoiding silicone arthroplasty. We review the literature on cartilaginous rib grafts in maxillofajcial and orthopaedic surgery. In our experience, MRI and biopsy show viable cartilage but also histologic changes such as revascularization, fibrous transformation and bone metaplasia

[Fingertip reconstruction with occlusive dressing: Clinical results and biological analysis of the dressing content's.]

International audienceOBJECTIVES: To evaluate the fingertip reconstruction with occlusive dressing and explore the mechanisms and the mediators of this "fingertip regeneration". PATIENT AND METHODS: Nineteen patients who sustained a fingertip injury were treated with occlusive dressing. Two prospective studies: a clinical analysis of the aesthetics and the functional results, a biologic analysis of the dressings in order to search microorganisms, cytokines, and growth factors. RESULTS: Among 15 patients reviewed, the healing was acquired in 2.7 weeks (2.5). The thickness of the fingertip was excellent in 30% and good in 70%. The Weber test was 3.8mm for the fingertip reconstruction against 3mm for the opposite side. The analysis of the dressing exudates brings to light a pullulement of saprophyte bacterium of the skin but also pathologic species, and presence of angiogenic factors (PDGF, VEGF, EGF). CONCLUSIONS: The occlusive dressings remain a reliable and reproducible alternative for treatment of fingertip injuries in zone 1 and 2. This reconstruction seems to depend on bacterium pullulement and cellular growth factors liberation