-Hello, some cases of debridement keratosis in our diabetic patients
at different sites.
You will see that it takes very little of equipment but a lot of compliance
and dexterity. Just number 10, number 15 blades.
or sterile, wrapped, disposable or non-sterile,
and also removable sleeves where you can install
with a Pean clamp, so a scalpel blade.
You can see that the blade is in place, that it's pretty easy with the Pean clamp
by lifting the left outer edge and then by shooting like in this picture.
First case, hyperkeratosis on the metatarsophalangeal joint
plantar of a first toe on a neuropathic hollow foot.
The patient feels absolutely nothing and has been walking on this callus for weeks.
He may have an evil under this callus plantar perforator, typical lesion
of the neuropathic diabetic patient. There's a pressure between the keratosis
and the bone plane that could create bursitis between keratosis
and the bone plane.
Now I'm going crazy, with a scalpel number 10 at the start,
the whole horn. You can see that I'm working
perpendicular to the skin. You go at the speed you want.
You can use small pliers plastic as I hold on my left hand
to also lift the skin, and you stretch well with your left thumb,
since I'm right-handed, the skin and the joint.
Now we're taking off, we could put an emollient
or you can also work dry, as in this clinical case.
You quietly detach all that horn.
Of course you're careful. that the tip of the scalpel is
slightly in the air so that it does not cause
a skin breach,
[pause]
and you can change the blade, switch to the number 15 blade if you prefer.
There is always support from the fourth and you see on the fifth finger
with my right hand, and I hold the scalpel like a pencil.
I stretch the skin with my left hand.
Don't forget the outside of the callus.
All keratosis must be gone and not just the location
where you think there would be maybe a lesion under the keratosis
which is not a priori the case, on this diabetic patient.
You see at the end of the treatment, a good lubrication and of course put
in landfill anyway with foot orthotics.
The heels, all the heels must be processed.
The diabetic patient has a skin excessively dry.
As soon as you have horn, keratosis, cracks,
rhagades, you have to remove, with a scalpel always, very simply
by lifting with the left hand the heel so as not to hit either
in the table, or by putting a cushion or a rolled napkin
under your patient's malleolus. Now the film is a little fast.
to go faster, and there's no lesion but there's a traumatic papilloma.
He's a patient who had a shoe. which was too fair, a flip-flop too fair,
and so it's the edge of the heel. that caused this keratosis.
See, there was a lot of support. since we have no horn at all,
on the other part of the foot. Rhagades are heels.
which are extremely complicated, they're real crevices,
it's more than a crevasse, which can be multiple,
right foot, left foot and on those rhagades, treatments based on
of salicylated vaseline, 15 days of salicylated vaseline,
to put sparingly on these heels.
Debridement of a pulp body.
Diabetic patient, little toe claw number two.
Pulp body, a little bit bloody. A thick nail.
You will see that I only use only one instrument,
Disposable scalpel number 15, sterile scalpel, gloves.
You're stretching your toe. Be careful not to cut yourself either
with this blade.
My left thumb is far behind the blade.
And we're going to have to remove as much as possible like this than all hemorrhagic cells.
Since I don't have any pliers that day, I have nothing but a scalpel,
you will also be able to treat the scalpel nail.
I turn the blade upside down when I go up. quietly and I'm out of here,
always a little bit of cotton with a little saline.
or sterile water, that's enough. It's black, I'm convinced
than under this pulpal body, there's a small hematoma, a small lesion,
a little plantar perforating foot pain, this patient is neuropathic,
who doesn't feel anything at all. I took the posterior tibial pulse
and the pedal pulse before the treatment. There was a good pulse,
the IPS is quite correct, so I can largely unleash
without causing bleeding, but I'm clearing the hematoma.
Currently you see that with the same blade, you can go to work.
around the nail. As soon as you have a nail and a wound,
you have to clear the nail, remove as much of this nail as possible.
[pause]
Now I go up, and I take off the nail, and I cut the nail.
with the same scalpel blade.
[pause]
When I said dexterity, yes, observance, separate the plans well,
the nail of the skin. The skin is white because it is macerated
with the hematoma that was there, it's not fibrin at all,
it's maceration. It is a pedicure treatment that is complete,
with very little equipment. Then I'm going to do a padding.
which means I'm going to put a rolled compress under the toe,
before interfacing, a greasy tulle or simply petroleum jelly.
On this diabetic patient, we won't forget about the care, of course.
of pedicures that are meticulous. The pulpal body of the third toe,
thickening of the nails, keratosis, grease and also
offer him, impose a shoe on him or a short discharge system
because I think that in two to three weeks, this small lesion will have healed.
A similar case of debridement pulpary with a nail milling.
A little bit more equipment, a pulpal body third toe
that I'm starting to unleash with a pair of pliers by cutting the nail out of the way
which is already very long, and at the same time by cutting off the keratosis
i. e. the pulpal body. Obviously, it is necessary to be able to evaluate
before the depth of keratosis so as not to cut the flesh either
and break into the skin.
I took a handle and placed it on it a sterile number 15 scalpel blade.
We always wear gloves and I debride this keratosis sparingly.
There the film is accelerated to go a little faster, and you'll see
that I'm going to release under the nail and then mill the nail.
The patient is neuropathic, doesn't perceive anything.
I'm holding my toe tight, in case the patient moves,
between my index finger and thumb with the left hand
to really supervise the site to be worked on.
[pause]
There is no wound under this keratosis. Once I've cleared the entire horn.
under the nail, I cut the nail with a pair of pliers. You see that the work is done
in several steps and then I'm going to mill with a strawberry.
in tungsten to complete the treatment. I could have started milling right from the start,
but I work much faster with the pliers and the scalpel already in place.
Now I only drink strawberry.
[pause]
You can from time to time pass a little sterile water
or saline solution in order to eliminate small waste.
You see that my left thumb is far behind the lesion
and then I take back the scalpel lastly
[pause]
small flaps of keratosis to be removed
[pause]
Care must be taken really very gently.
and a good lubrication of the entire toe, with all the foot, by the way, is enough,
of course with advice of footwear since a priori
this toe stumbles into a shoe too small.
[pause]