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In a randomized trial in patients with moderate Dupuytren’s contracture, collagenase was not noninferior to limited fasciectomy with respect to the Patient Evaluation Measure score at 1 year after treatment.

Background Dupuytren’s contractures are fibrous cords under the skin of the palm of the hand. The contractures are painless but cause one or more fingers to curl into the palm, resulting in loss of function. Standard treatment within the NHS is surgery to remove (fasciectomy) or divide (fasciotomy) the contractures, and the treatment offered is frequently determined by surgeon preference. This study aims to determine the feasibility of conducting a large, multicentre randomised controlled trial to assess the clinical and cost-effectiveness of needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren’s contracture. Methods/design HAND-1 is a parallel, two-arm, multicentre, randomised feasibility trial. Eligible patients aged 18 years or over who have one or more fingers with a Dupuytren’s contracture of more than 30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints, well-defined cord(s) causing contracture, and have not undergone previous surgery for Dupuytren’s on the same hand will be randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy. Participants will be followed-up for up to 6 months post surgery. Feasibility outcomes include number of patients screened, consented and randomised, adherence with treatment, completion of follow-up and identification of an appropriate patient-reported outcome measure (PROM) to use as primary outcome for a main trial. Embedded qualitative research, incorporating a QuinteT Recruitment Intervention, will focus on understanding and optimising the recruitment process, and exploring patients’ experiences of trial participation and the interventions. Discussion This study will assess whether a large multicentre trial comparing the clinical and cost-effectiveness of needle fasciotomy and limited fasciectomy for the treatment of Dupuytren’s contractures is feasible, and if so will provide data to inform its design and successful conduct. Trial registration International Standard Registered Clinical/soCial sTudy Number: ISRCTN11164292 . Registered on 28 August 2015.

Purpose Fasciotomy is a surgical procedure that involves the incision of fascial compartments in the body to relieve pressure, prevent tissue damage, and maintain blood flow. This study aimed to investigate the effectiveness of the Bogota Bag technique in closing fasciotomy wounds in patients with lower limb compartment syndrome. Methods A prospective cohort study was conducted between October 2022 and October 2023 to document our experience in employing the Bogota Bag technique for fasciotomy closure. The study included the evaluation of medical files from fifteen patients aged 17 to 61. Results The outcomes of the study present the initial series of limb fasciotomies treated with the Bogota Bag technique. Fifteen patients (14 male, 1 female) were included in the study. The average age of the patients was 34.73 ± 13.9 years and the average hospitalization was 8.33 ± 3.2 days. The average closure time of fasciotomy is 3.6 ± 1.4 days. Conclusion This report makes a significant contribution as the first documented series of limb fasciotomies treated with the Bogota Bag technique. This method exhibits simplicity in execution, cost-effectiveness, and a low incidence of complications.

Purpose Plantar fasciitis is a frequent and painful condition with a lifetime incidence of 10%. Good results have been reported for operative treatment of plantar fasciitis refractory to non-surgical interventions in uncontrolled studies. The aim of this study was to compare the results of operative treatment (endoscopic debridement, removal of the heel spur and partial resection of the plantar fascia) with those of a controlled and supervised non-operative rehabilitation program. Methods Thirty consecutive patients with plantar fasciitis during more than 3 months were randomized to either (1) non-operative treatment with corticosteroid injections and a controlled strength training program or (2) an endoscopic 2-incision operation with partial fasciotomy and heel spur removal followed by the same strength training program. Patients were evaluated at entry and 3, 6, 12 and 24 months post-operatively with the foot function index (FFI) and pain score during activity on a 100 mm VAS scale (VAS activity). FFI at 6 and 12 months was defined a priori as primary endpoint. Results Both groups improved significantly over time. The FFI score was significantly better in the operated group compared to the non-surgically treated group 12 months post-operatively ( p  = 0.033), at 24 months this was, however, not significant ( p  = 0.06). VAS activity at 24 months was significantly ( p  = 0.001) in favor of the operative group. More patients returned to running and jumping in the operative group ( p  = 0.04). Conclusion This randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program. Level of evidence I.

Plantar fascia (PF) is the commonest causes of foot pain in the adult population. Several surgical treatments are available to treat PF. This study was aimed to investigate the clinical efficacy of three different treatments for plantar fasciitis. It was conducted among 60 patients, divided equally into three treatment groups named Needle Knife Therapy, Endoscopic Plantar Fasciotomy, and Conventional Painkillers. Descriptive and analytical analysis were done by using SPSS 25 software. VAS and AOFAS scores were analyzed. The maximum ( n  = 31) participants were in 41–60 year age range group with normal BMI. These differences of mean VAS and AOFAS pain scores between different treatment groups were statistically significant (One-way ANOVA, p  < 0.01). Both scores found lower in the Endoscopic Plantar Fasciotomy group. This study opens a new window of knowledge to achieve sustained pain relief and functional improvement. Moreover, the superiority of Endoscopic Plantar Fasciotomy in treating plantar fasciitis compared to Needle Knife Therapy and Conventional Painkillers was explored.

Wound closure is an integral part of every spinal procedure. Effective and secure wound closure is paramount in the prevention of infection, wound dehiscence and the preservation of cosmesis. Barbed suture technologies such as STRATAFIX™ Symmetric have been studied and are used in a variety of specialties, including obstetrics and orthopedic surgery, but is underutilized in neurosurgery. This study aims to assess the time and rate of closure using STRATAFIX™ Symmetric technology for fascial closure and compare this method to the more traditionally used method of fascial closure using braided absorbable sutures below the epidermis. 20 patients were recruited for the study. 10 patients underwent fascial approximation with braided absorbable sutures and definitive fascial closure with STRATAFIX™ Symmetric. In the control group, fascial closure was completed entirely with interrupted braided absorbable stitches. Patients assigned to STRATAFIX™ Symmetric group had shorter mean time for fascial closure, faster rate of average fascial closure, and lower number of total sutures used. The use of barbed suture technology such as STRATAFIX™ Symmetric may reduce the time to closure in thoracolumbar spine surgery without increasing the risk of adverse events. This pilot study forms the framework for a larger randomized, controlled trial appropriately powered for such an analysis.

Purpose Primary objective was to compare the rates of parastomal hernia (PH) at 2 years after the creation of a terminal colostomy using two types of fascial incision: cross-shaped and reinforced longitudinal. Secondary objectives included the evaluation of postoperative complications, readmissions, reoperations for PH, and patients’ quality of life. Methods This was a multicenter superiority clinical trial conducted at 5 hospitals involving patients with rectal cancer and definitive colostomy. Patients were randomized into two groups: cross incision ( n  = 42) or reinforced longitudinal incision ( n  = 52), for the exteriorization of the colon in terminal colostomy. PH at 2 years was determined by physical examination, computed tomography (CT), and symptoms. Baseline data on risk factors for PH, postoperative complications, readmissions, reoperations for symptomatic PH, and quality of life were recorded. Results A total of 95 patients were included: cross ( n  = 42) and reinforced longitudinal ( n  = 52). Demographic characteristics, risk factors for PH, and surgical factors were similar between the two groups. No significant differences were found in the clinical PH rate between the cruciate versus longitudinal incision groups (48.60% vs. 45.20%; p  = 0.770), radiological PH (54.30% vs. 53.70%; p  = 0.956), or symptomatic PH (14.30% vs. 19%; p  = 0.579). The comprehensive complication index (CCI), readmissions, and reoperation rates for symptomatic PH (8.6% vs. 7.1%; p  = 0.816) were similar in both groups. No significant differences were observed in the three health aspects evaluated using the EORTC QLQ-C30 scale. Conclusion The reinforcement of a longitudinal fascial incision as an isolated surgical technique does not reduce the incidence of PH after a 2-year follow-up.

Purpose This study was planned to evaluate limb survival and clinical outcomes of fasciotomies done before and after 24–48 h due to compartment syndrome in the extremities caused by crush injuries after the earthquakes in Turkey on February 6–7, 2023. Methods We retrospectively analyzed 129 extremities of 84 patients that underwent fasciotomy after the 2023 Turkey earthquakes in this single center study. Demographical data of patients, affected limb, time to fasciotomy, limb survival, number of debridements, necrotic muscle debridement, whether graft-flap was needed, and the need for hemodialysis were analyzed. Extremities were grouped according to timing of fasciotomy (24–48 h) and subgroups were defined in terms of affected limb (upper/lower). Result 43 females (51.2%) and 41 males (48.8%) were included in the study. Mean age of patients was 34.5 ± 12.8 years. There were 39 upper, 90 lower extremities totaling 129. Amputations were performed in 25 (19.4%) extremities of 20 (23.8%) patients of which 5 were upper (5 transhumeral) and 20 were lower (3 hip disarticulation, 7 transfemoral, 10 transtibial). There was no need for amputation in patients fasciotomised within 24 h. Amputation was performed in 9 (11.5%) of 78 extremities fasciotomized between 24 and 48 h and in 16 (31.4%) of 51 extremities fasciotomized after 48 h ( p  = 0.005). Amputation rates were significantly higher in lower extremities after 48 h ( p  = 0.002) in contrast to upper extremities ( p  = 0.661). The median number of debridements in all extremities was 2 [ 1 , 2 , 3 – 4 ]. Muscle compartment excision was required in 27 extremities (%26). Of the remaining 34 upper extremities, 17 (50.0%) were closed with graft/flap application and of the remaining 70 lower extremities, 25 (35.7%) were closed with graft/flap application. 19 patients (22.6%) received hemodialysis, with significantly higher rate with late fasciotomies ( p  < 0.001 and 0.004 for 24 h and 48 h respectively). Conclusion Fasciotomies earlier than 24 h prevented amputation and rate of muscle compartment excision was higher in fasciotomies done after 24 h especially for lower extremities. Upper extremity fasciotomy timing early or late did not change the outcomes.

Spine surgery is essential for restoring alignment, stability, and function in patients with cervical spine injuries, especially when instability, pain, deformity, or progressive nerve damage is present. Effective wound closure is vital in these procedures, aiming to promote rapid healing, reduce infection risks, enable early mobilization, and ensure satisfactory cosmetic results. However, there is limited evidence on the optimal wound closure technique for posterior spine surgery, highlighting the need for innovative approaches. A study by Glener et al. evaluated the effectiveness of STRATAFIX™ Symmetric barbed sutures compared to traditional braided absorbable sutures in spinal surgery. In a randomized trial involving 20 patients, the STRATAFIX™ group demonstrated a shorter mean closure time and significantly fewer sutures used, though without a statistically significant reduction in closure time. No significant differences were observed in postoperative complications between the groups during a six-month follow-up. While the findings suggest potential cost savings and efficiency improvements with STRATAFIX™, the study’s small sample size and short follow-up period limit its generalizability. Furthermore, AI-based models, such as the Xception deep learning model, show promise in improving suture training accuracy for medical students, which could enhance surgical outcomes and reduce complications. Despite the promising results, further research with larger sample sizes, extended follow-up periods, and multi-center trials is necessary to validate the effectiveness of barbed sutures like STRATAFIX™ in neurosurgery. The integration of AI in surgical training and continued exploration of innovative techniques are essential to advancing the field and optimizing patient care in spinal surgery.

Background Dupuytren’s contracture is a hereditary disorder which causes progressive fibrosis of the palmar aponeurosis of the hand, resulting in digital flexion contractures of the affected rays. Limited fasciectomy is a standard surgical treatment for Dupuytren’s, and the one with the lowest recurrence rate; however, the recurrence is still relatively high (2–39%). Adipose-derived stem cells have been shown to inhibit Dupuytren’s myofibroblasts proliferation and contractility in vitro, as well as to improve scar quality and skin regeneration in different types of surgeries. Autologous adipose tissue grafting has already been investigated as an adjuvant treatment to percutaneous needle fasciotomy for Dupuytren’s contracture with good results, but it was only recently associated with limited fasciectomy. The purpose of REMEDY trial is to investigate if limited fasciectomy with autologous adipose tissue grafting would decrease recurrence compared to limited fasciectomy alone. Methods The REMEDY trial is a multi-centre open-label randomised controlled trial (RCT) with 1:1 allocation ratio. Participants ( n  = 150) will be randomised into two groups, limited fasciectomy with autologous adipose tissue grafting versus limited fasciectomy alone. The primary outcome is the recurrence of Dupuytren’s contracture on any of the treated rays at 2 years postoperatively. The secondary outcomes are recurrence at 3 and 5 years, scar quality, complications, occurrence of algodystrophy (complex regional pain syndrome), patient-reported hand function, and hypodermal adipose tissue loss at 1 year postoperatively in a small subset of patients. Discussion The REMEDY trial is one of the first studies investigating limited fasciectomy associated with autologous adipose tissue grafting for Dupuytren’s contracture, and, to our knowledge, the first one investigating long-term outcomes of this treatment. It will provide insight into possible benefits of combining adipose tissue grafting with limited fasciectomy, such as lower recurrence rate and improvement of scar quality. Trial registration ClinicalTrials.gov NCT05067764, June 13, 2022.