Chirurgie de la main
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First described by Ambroise Paré in the mid-17th century complex, regional pain syndrome (CRPS) can be defined as an articular and periarticular pain syndrome associated with vasomotor deregulation triggered by various stresses with no relationship between the intensity of the initial injury and severity of the continuing pain. Several names have been given to Type 1 complex regional pain syndrome (CRPS-I): causalgia, reflex sympathetic dystrophy, shoulder-hand syndrome and algodystrophy. The reported incidence of CRPS-I is about 25 per 100,000. ⋯ Some of the proposed treatments include NSAIDs, antidepressants and anticonvulsants. The latter, despite their good analgesic effects, do not cure CRPS-I. In select cases, a surgical procedure aiming at removing a nociceptive stimulus can lead to spectacular improvements.
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Chirurgie de la main · Oct 2013
[Autologous fat grafting in the surgical management of painful scar: preliminary results].
The purpose of this study was to report our experience about the effectiveness of autologous fat injections in the management of painful scars. Between 2010 and 2012, all patients with persistent incisional pain despite a well-conduced 6 months medical treatment received an autologous fat graft according to the technique originally described by Coleman. Results interpretation was based on pain improvement thanks to a Visual Analogic Scale (VAS), postoperative patient satisfaction, reduction on analgesics intake and quality of life improvement. ⋯ The mean reduction of VAS was 3.5 points. We did not observe any complication. Autologous fat grafting is an innovative therapeutic approach and appears to be an attractive concept in the management of scar neuromas resistant to drug treatment, by providing an easy effective and safe surgical treatment.
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Chirurgie de la main · Sep 2013
Review Case Reports[Compression of the superficial branch of the radial nerve by a synovial ganglion of the elbow (about one case and literature review)].
Compression of the radial nerve at the elbow is quite rare; entrapment of its superficial branch is exceptional. Extrinsic compression is the most frequent etiology. Magnetic resonance imaging plays a major role in the diagnosis, and early surgical excision or echoguided drainage - in case of synovial ganglion - allows a total recovery. The authors report the case of a compression of the superficial branch of radial nerve by an elbow synovial cyst treated by surgical resection.
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Chirurgie de la main · Sep 2013
Case ReportsContinuous in situ diffusion of ropivacaine for ambulatory congenital hand disorders surgery in young children.
Pediatric ambulatory surgery presents a specific set of challenges to the anesthesiologist. Similarly to adult ambulatory surgery, we report four ambulatory surgical procedures in two young children with congenital hand disorders. For each surgical procedure pain was controlled with continuous in situ infusion of ropivacaine.
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Chirurgie de la main · Sep 2013
Case Reports[Comorbid puffy hand syndrome and factitious disorders: an unusual association with poor prognosis].
The authors report an original clinical presentation of factitious disorders of the upper extremity in an ex-drug-addict patient with puffy hand syndrome. Chronic self-inflicted ulcerations appeared with sequential manner. The patient confessed deliberate self-harm and transfer of anxiety on his hands, the aspect of which had become intolerable. Association of puffy hand syndrome with comorbid psychosis and major depression explained immediate recurrence of ulcerations despite fitted medication and long-term psychotherapy.