La Revue du praticien
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Sciatic pain is often misleading and establishing the link with a local muscular cause can be difficult and lead to errors, especially when faced with a young sportsman, with typical discogenic pain. Simple, specific and reproducible tests enable a better identification and treatment of a muscular cause or canal syndrome. Physiotherapy, or local infiltrations are generally very efficient, and sufficient. Surgery may be considered only in a very limited number of cases, lack of response to the first line treatment and then only if it is the absolute diagnosis, diagnosis which must remain a diagnosis of exception, more so of exclusion.
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This review discusses current therapeutic options for leg ulcers. Compression therapy remains the first-line treatment for venous ulcers, with the use of an external pressure of 30 to 40 mmHg at the ankle (0.8 < ABPI < 1.3). Superficial vein surgery does not improve healing rates of venous ulcers; however it has been shown to reduce ulcer reoccurrence in the context of a competent deep venous system. ⋯ Systemic antibiotics should be considered only if the ulcer presents clinically significant infection (spreading erythema, cellulitis, purulent exudates and fever). Choose a type of dressing depending on the phase of healing and on particulars situations (infection, hemorrhagic, malodorous wounds, dermatitis of surrounding skin). In addition to conventional therapeutic options, patient education and lifestyle interventions should not be forgotten.
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The beneficial effect of a moist wound environment has been well established for healing rate of acute wounds, pain relief and debridement of chronic wounds. Modern dressings are occlusive or semi occlusive, classified according to their physical composition and to their performances such as absorbent capacity, hydrating ability, adhesive components and debridement capacity. ⋯ Nevertheless, the indications of modern dressings were recently determined according to a systematic review of the literature and to a formal consensus process. Despite the lack of appropriate studies, modern dressings remains a part of the standard of care and are widely used according to the experience of the clinicians, in larger indications than what may be recommended by evidence-based medicine.