Pyrocardan® implant after failed trapeziectomy.

The aim of this retrospective study was to analyze the medium-term results of patients treated with a pyrocarbon interposition implant (Pyrocardan®, Wright Medical™) after failed trapeziectomy. Eight female patients with an average age of 63 years were included in this single-center study. The average follow-up was 54 months (28-85 months). The average time elapsed between the trapeziectomy and the revision surgery was 116 months. Trapeziectomy failures were due to a painful scaphometacarpal and/or metacarpotrapezoid impingement. Patients were assessed radiologically and clinically for range of motion, strength (pinch and grip), pain (visual analog scale - VAS) and function (QuickDASH and PRWE scores). We found pain reduction with the mean VAS decreasing from 6.3 preoperatively to 2.5 postoperatively. Function improved with the QuickDASH and PRWE scores going from 52.9 and 49.1 preoperatively to 30.7 and 31.0 at the last follow-up, respectively. Strength and range of motion did not change significantly. Seven patients were satisfied or very satisfied with the surgery, while one patient did not experience any improvement after surgery. There was no radiological evidence of dislocation or bone reaction around the implant. Revision of failed trapeziectomy with the Pyrocardan® implant in cases of severe and painful first metacarpal subsidence is an effective solution that improves pain and function in the medium term.

Effect of cryotherapy on pain and analgesic consumption after wrist or thumb surgery.

Cryotherapy has demonstrated its efficacy in post-traumatic soft tissue pain, through its anti-inflammatory action. Its postoperative use has also been the topic of many studies and has now proved its efficacy in indications such as ligament or knee arthroplasty surgery. The aim of this study was to analyze the effect of cryotherapy on pain and analgesic consumption after wrist or base of the thumb surgery. We prospectively included 60 patients from March 2017 to May 2018. All these patients had undergone wrist or base of the thumb surgery involving a bone procedure. Thirty patients were managed with cryotherapy (the Handfreez® splint), 30 patients were included in the control group with conventional immobilization. The data collected included a visual analogue scale (VAS), and analgesic and non-steroidal anti-inflammatory drug (NSAID) consumption, both during the hospital stay and then at home for one week. The results from the two groups were compared. During the hospital stay, morphine consumption was significantly lower in the cryotherapy group (p = 0.04). At home, NSAID consumption was significantly lower in the cryotherapy group (p = 0.009). The VAS score was not significantly different between the two groups. In our study, we demonstrated the benefits of cryotherapy on consumption of analgesics and NSAIDs after bone surgery of the wrist or the base of the thumb.

Vein conduits used to enhance arterial microsurgical end-to-end suture repair: A randomized comparative study.

Wrapping microsurgical sutures with a vein conduit is a well-described procedure for microsurgical nerve repair. While this has rarely been described in the context of vascular repair, this technique could increase the permeability of the sutured vessels. As part of a University Diploma in Microsurgery, 9 junior surgeons performed a comparative study of 18 microsurgical repairs on rats with and without vein sleeve. The vessels used were an external jugular vein sleeve on the end-to-end anastomosis of the common carotid artery and comparing it to this same anastomosis without a sleeve. The data analyzed were rat weight, suture time with carotid clamping time, number of stitches used, complications as well as vascular leakage and permeability of the repair at 0 and 5minutes evaluated with a patency test. The average rat body weight was 255g. Mean suture time was 52minutes in group A (sleeved repairs) and 41minutes in group B (standard repairs). The number of stitches placed was 5.1 points on average in group A and 5.6 points in group B. The time to perform the repair and the number of stitches was not statistically different between groups. The patency test was positive in 100% of cases in group A and in 78% of cases in group B. There was a significant difference between the permeability rate of the repairs, with better results in group A (p=0.03). There were two anastomotic leaks after declamping in the sleeve group and five in the standard suture group, thus 2.5 times more leaks in the group without a sleeve (p<0.01). The addition of a vein sleeve around an end-to-end arterial suture repair seems to improve its permeability and therefore its reliability.