Essai contrôlé randomisé de 2 procédures de traitement des amputations digitales distales traumatiques en zone 2 et 3 : pansement semi-occlusif versus lambeau local/thèse présentée pour le diplôme de docteur en médecine, diplôme d'État, mention

Médecine (chirurgie orthopédique et traumatologique)Distal finger amputations are one of the traumas frequently encountered in emergency rooms. Many treatments exist for amputations in zone 2 and 3 without a management algorithm. The main goal of treating these lesions should be the recovery of sensitivity. This is a prospective, randomized and multicenter study to compare two methods of treatment of amputations in zone 2 and 3 of Ishikawa: a conservative treatment by semi-occlusive dressing (Group 1) and a surgical treatment by performing a local flap (Group 2). 23 patients were included in group 1 and 21 patients in group 2. The primary endpoint concerned recovery of sensitivity at 1 year with the Semmes-Weinstein monofilament test. At 1 year, the fine sensitivity to the monofilament test in group 1 on the injured side was on average 0.76 g against 0.47 g on the healthy side. In group 2, on the injured side, it was on average 0.72 g against 0.36 g on the healthy side (p = 0.198). The most common complications were nail dystrophy, cold intolerance, and dysesthesia and stiffness of the proximal interphalangeal joint. Pulp trophicity at the end of treatment was satisfactory except for amputations in zone 3 treated with a semi-occlusive dressing without prior bone trimming. We recommend conservative treatment with a semi-occlusive dressing for Ishikawa Zone 2 amputations. For amputations in zone 3, the surgical treatment with a local flap seems to provide better pulpal trophicityThèses et écrits académique