[Retrospective Long-Term Results After Dellon's Nerve Decompression In The Lower Leg For Polyneuropathy]. / Retrospektive Langzeitergebnisse nach einer Nervendekompression nach Dellon am Unterschenkel bei Polyneuropathie.

BACKGROUND: Patients affected by polyneuropathy often report pain, paraesthesia and numbness and are at risk of having an increased propensity to fall with the corresponding complications. In case of persistent symptoms after all conservative and medical treatment options have been exhausted, a nerve decompression in the lower leg as described by Dellon can lead to an improvement of the discomfort for many patients. This article presents our long-term results with Dellon's operation. METHODS: In this retrospective study, we included 33 patients with diabetic or idiopathic polyneuropathy in whom we performed Dellon's nerve decompression in the lower leg in the years 2011-2013. In 29 out of the 33 patients, we investigated the level of pain (according to the numeric rating scale NRS 0-10), paraesthesia, numbness, Hoffman-Tinel sign, and Semmes-Weinstein monofilaments three months postoperatively. 88 months postoperatively (range 78-111 months), we were able to contact 20 of the 33 patients with a questionnaire asking about their present pain level (NRS 0-10), satisfaction with the postoperative result (NRS 0-10, 0=most satisfied, 10=not satisfied at all) and whether the patients would recommend the surgical procedure to their friends or family. RESULTS: 1. Significant pain reduction three months postoperatively, NRS 4.5 to 2.2, (p=0.000). 2. Significant reduction of paraesthesia three months postoperatively from 84.8 to 24.2% (p=0.000) 3. Significant reduction of numbness three months postoperatively from 97% to 39% (p=0.000). 4. Significant improvement of sensitivity three months postoperatively from 91% no sensitivity to 28% no sensitivity (p=0.000). 5. Significant improvement of Hoffmann-Tinel sign three months postoperatively from 76% to 13% (p=0.000). 88 months postoperatively, we saw a significant pain reduction from an average preoperative pain level of NRS 4.5 to a postoperative pain level of 2.7 (p=0.048). 88 months postoperatively, 65% of the patients would recommend the surgical procedure to their family and friends, and patient satisfaction was high (NRS 3,4). CONCLUSION: Our long-term results show that Dellon's nerve decompression in the lower extremities leads to a marked, lasting pain reduction and a functional improvement.

Nerve Decompression in the Lower Leg Results in an Improvement in Symptoms in Patients With Both Diabetic and Idiopathic Polyneuropathy.

BACKGROUND: Patients suffering from polyneuropathy often complain of pain, tingling, and numbness sensations, as well as an increased risk of falling with the corresponding subsequent complications. If symptoms persist after conservative treatment options have been exhausted, nerve decompression in the lower extremity, as described by Dellon, can bring about an improvement in symptoms in many patients. Dellon originally reported that this surgery led to very successful outcomes in patients with diabetic polyneuropathy. In this study, we compare our postsurgical results in patients with diabetic versus idiopathic polyneuropathy. METHODS: Thirty-three patients with idiopathic or diabetic polyneuropathy who had undergone Dellon nerve decompression in the lower extremity between 2011 and 2013 were included in the retrospective study. Pain (numeric rating scale [NRS] 0-10; 0, no pain; 10, worst imaginable pain), tingling, numbness, Hoffmann-Tinel sign, and Semes-Weinstein monofilament were assessed in 20 patients with diabetic polyneuropathy and in 13 patients with idiopathic polyneuropathy. RESULTS: Three months after surgery, a significant reduction in pain was evident in patients with diabetic polyneuropathy, from a preoperative level of NRS 4.9 (minimum, 0; maximum, 10) to 2 (minimum, 0; maximum, 8; P = 0.005). Ninety percent of patients complained of tingling ( P = 0.000) before surgery and 18% after surgery, whereas 100% complained of numbness before surgery and 41% ( P = 0.000) after surgery. One hundred percent of patients had no measurable surface sensitivity before surgery (measured with the Semes-Weinstein monofilament), whereas 3 months after surgery, only 24% of patients still had no measurable surface sensitivity ( P = 0.000). A positive Hoffmann-Tinel sign was recorded in 85% of patients before surgery and only in 11% 3 months after surgery ( P = 0.000). In the case of patients with idiopathic polyneuropathy, a reduction in pain was evident 3 months after surgery, from a preoperative level of NRS 3.9 (minimum, 0; maximum, 9) to 2.2 (minimum, 0; maximum, 9; P = 0.058). Seventy-seven percent of patients complained of tingling before surgery and 42% after surgery ( P = 0.111), whereas 92% complained of numbness before surgery and 50% after surgery ( P = 0.030). Seventy-seven percent of patients had no measurable surface sensitivity before surgery (measured with the Semes-Weinstein monofilament), whereas 3 months after surgery, only 33% of patients still had no measurable surface sensitivity ( P = 0.047). A positive Hoffmann-Tinel sign was recorded in 62% of patients before surgery and only in 17% 3 months after surgery ( P = 0.041). CONCLUSIONS: Not only patients with diabetic polyneuropathy but also those with idiopathic polyneuropathy benefit from Dellon nerve decompression surgery in the lower extremities.

[A prospective Study about medium-term Results after autologous Fat Transplantation into arthritic CMC-I-joints]. / Prospektive Untersuchung der mittelfristigen Ergebnisse nach autologer Fetttransplantation in arthrotische Sattelgelenke.

PURPOSE: Prospective study to evaluate the midterm results after transfer of autologous fat into osteoarthritic CMC-I-joints. PATIENTS AND METHODS: 23 out of 27 patients (22 females and 5 men) with an average age of 59,8 (49-83) years with osteoarthritis of the CMC I joint were treated with a fat transfer into the damaged joints. The follow-up was 45,3 (39,3-50,9) months. 4 patients were excluded from the follow-up because of a resection arthroplasty in the meantime. Grip strength and pinch strength, DASH questionnaires and pain (VAS) were analysed. RESULTS: The average pinch strength increased from preoperatively 3,7 kg to 5,1 kg postoperatively (p = .052). The average grip strength increased minimally from preoperatively 22,2 kg to 22,8 kg at follow-up (p = .506). The average DASH score improved significantly from preoperatively 50,8 to 29,6 postoperatively (p = 0,000). The average pain level decreased significantly from preoperatively 5,9 to 1,9 at follow up (p = .000). Patients with an advanced osteoarthritis of the CMC-I-joint had similar results as patients with a minor osteoarthritis. CONCLUSION: The autologous fat transfer into the osteoarthritic CMC-I-joint showed in midterm follow-up good to very good clinical results regarding pinch strength, pain and DASH score. It is a safe minimal invasive promising alternative to accepted surgical therapies in the treatment of osteoarthritis of the CMC-I-joint.

[The effects of standardised cold and compression therapy on swelling, pain and functional outcome after division of the transverse carpal ligament in carpal tunnel syndrome]. / Der Einfluss von standardisierter Kälte- und Kompressionstherapie auf Schwellung, Schmerzhaftigkeit und das funktionelle Ergebnis nach Spaltung des Retinaculum flexorum bei Karpaltunnelsyndrom.

OBJECTIVE: This prospective, randomised study examines the effect of standardised cold compression therapy on swelling, pain and functional outcome after division of the transverse carpal ligament in carpal tunnel syndrome in comparison to cooling alone. PATIENTS AND METHODS: Fifty patients for division of the transverse carpal ligament were randomised into two groups. In group 1, postoperative conventional cooling therapy was performed. Group 2 was given standardised cooling and compression therapy with the Cryo/Cuff™-system (3 × 10 min twice daily). Follow-up examinations were performed on days 1, 8 and 21 after the operation. One patient in group 1 and 3 patients in group 2 could not be followed up. Test parameters were pain, swelling, mobility, strength, and the DASH and MHQ score. RESULTS: There were no significant differences between the two groups at any time point. CONCLUSION: In this study, no advantage could be demonstrated for standardised cooling and compression therapy with the Cryo/Cuff™-system in comparison with conventional cooling after division of the transverse carpal ligament.

Anatomical study of the human sole of the foot by 4-dimensional CT angiographic vascular imaging - its suitability as composite tissue allotransplantation graft for foot defects.

BACKGROUND: The reconstruction of the weight-bearing sole is a challenge for every plastic surgeon. Composite tissue allotransplantation (CTA) of the sole of the foot may be a good therapeutic option for patients with large defects in the weight bearing area of the foot. As part of the preparation for a CTA of the sole, we sought to prepare for technical aspects related to preparation and perfusion of the human sole, on the basis of a systematic anatomical study, in combination with 4-dimensional computed tomography-angiography. MATERIAL/METHODS: An anatomical study was performed on 10 cadaver feet. CT images of the feet were prepared in a GE light speed 16-line computed tomogram (CT) before and after the preparation of the sole. After each CT scan, contrast medium was injected in 0.2 ml steps over the posterior tibial artery. RESULTS: Good images of the vessels of the sole from all 10 feet were achieved after recovery of the posterior tibial artery with accessory veins, the tibial nerve, the medial calcaneal branches from the posterior tibial artery, the abductor hallucis, digitorum brevis, abductor digiti minimi, lumbricales and interossea plantares muscles, even after preparation of the soles. CONCLUSIONS: With this systematic anatomical preparation of the soles of the feet from human cadaver preparations, in combination with 4-dimensional CT angiography, we were able to demonstrate the technical feasibility of sole transplantation. CT angiography should be performed preoperatively, in order to demonstrate that the vessels are patent as pedicle for the sole of the foot.