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A C Masquelet

Publications and source records attributed to A C Masquelet.

At least 37 records · Page 2Linked to original sources
PubMed1999

The medial and inferior calcaneal nerves: an anatomic study.

The existence of chronic heel pain induced by the compression of nerves prompted us to conduct an anatomic study of the innervation of the heel. Fifteen cadaver feet were dissected to investigate the origin, course and branches of the medial calcaneal nerve (MCN) and the inferior calcaneal nerve (ICN). Despite a variable origin (tibial n. (TN) or lateral plantar n. (LPN)), the medial calcaneal nerve branches which lay superficial to the abductor hallucis muscle (AH) were quite constant. The medial calcaneal nerve gave branches to the abductor hallucis muscle and innervated the posterior part of the medial face of the heel. It terminated in the superficial heel pad at the inferior part of the heel. In our study, the inferior calcaneal nerve always originated from the lateral plantar nerve. Its relationship to the deep fascia of the abductor hallucis muscle and anterior tubercle of calcaneus may explain the entrapment syndrome of the inferior calcaneal nerve.

Ankle↗
PubMed1999

The medial malleolar network: a constant vascular base of the distally based saphenous neurocutaneous island flap.

Based on 30 fresh cadaver dissections a detailed anatomic study of the medial malleolar network is presented with particular attention to the anastomoses between the latter and the vascular axis that follows the saphenous nerve. The medial malleolar network is formed by the anterior medial malleolar artery, branches from the medial tarsal arteries, the posterior medial malleolar artery and branches from the medial plantar artery. A distinct anterior medial malleolar artery and posterior medial malleolar artery could be identified in 80 and 20%, respectively, as well as constant additional small branches arising from the anterior tibial or posterior tibial artery. A constant anastomosis was found between the arcade formed by the medial tarsal arteries and the medial plantar a. in 60%, and the medial branch of the medial plantar artery in 40%, respectively. This anastomosis always gave rise to branches to the medial malleolar network. In the perimalleolar area and with regard to the great saphenous v. a larger anterior and a smaller posterior branch of the saphenous nerve was found in 100 and 90%, respectively. In all dissections, for both branches of the saphenous nerve two to four small, but distinct anastomoses between the medial malleolar network and the perineural vascular axis were identified. These constant anastomoses represent a new and reliable vascular base for the distally-based saphenous neurocutaneous island flap. Thus, the pivotal point of the flap can be chosen in the area of the medial malleolus without respecting the most distal septocutaneous anastomosis between the perineural vascular axis and the posterior tibial artery. Additionally, an illustrative clinical case is presented.

Adult↗
PubMed1999

Anatomic study of the distally based vastus lateralis muscle flap.

The anatomy of the vascular perforation to the distal portions of the vastus lateralis muscle has been studied in 20 cadaver extremities to outline the vascular basis for distally based vastus lateralis muscle flap. From the 15.4 +/- 2.4, 11.8 +/- 1.7, and 7.9 +/- 2.0 cm distally to the patella, three quite large branches that issue from the deep femoral artery with the mean diameter of 2.8 +/- 0.2, 2.6 +/- 0.2, and 2.2 +/- 0.3 mm, respectively, distribute the distal parts of vastus lateralis muscle. These branches are thought to be an anatomic basis for the distally based vastus lateralis muscle flap. This allows the distally based vastus lateralis muscle flap to be raised for coverage of defects (1) in the popliteal fossa posterior and inferior portions of the knee anteriorly, (2) in the proximal one-third of the leg, and (3) for a below-knee amputation and the rotation of muscle tissue, such as when the gastrocnemius and soleus muscle are unavailable.

Female↗
PubMed1999

[Neurocutaneous flap of the anteromedial aspect of the thigh with a distal pedicle. Anatomical study and clinical application].

The authors report an anatomic study of the vascularization of the medial aspect of the thigh on 21 cadaveric dissections with injection. They describe a neuro-cutaneous medial thigh flap, with a distal pedicle, vascularised by proximal branches of the saphenous artery (branch from the descending genicular artery). This flap includes the medial femoral cutaneous nerve, which runs with a supra-aponeurotic vascular network. The anatomic variants and harvesting technique of this flap are described. Our clinical experience is based on 3 patients operated between 1996 and 1998, for coverage of an amputation stump. The results were excellent in all cases with a follow-up of 6 months to 3 years. The good quality of this skin coverage allows satisfactory adaptation of the leg prosthesis in our cases.

Adult↗
PubMed1998

The reversed-flow medio-distal fasciocutaneous island thigh flap: anatomic basis and clinical applications.

A new fasciocutaneous reversed-flow island flap of the thigh is presented which is independent of the presence of perfused blood vessels below the level of the knee joint-line. The pedicle, which is supplied by the proximal genicular anastomotic network, consists of the osteoarticular branch (OAB) and concomitant veins of the descending genicular artery. Based on cadaver dissections the OAB arose in 23/30 specimens (77%) together with the saphenous artery (SA). In 2/30 specimens (7%) the OAB originated directly from the superficial femoral artery and in 1/30 specimens (3%) the OAB was absent. The OAB gave off one to three cutaneous branches to the overlying skin in 26/30 specimens (87%). We were able to elevate a flap on the osteoarticular branch alone in 57%. Additional length could be added to the pedicle in 33% by including the most proximal part of the saphenous artery together with its first cutaneous branch. Thus, in 90% of the dissections a reversed-flow island flap could be raised which reached the proximal half of the leg, the knee and the most distal part of the thigh. We report our early clinical experience.

Aged↗
PubMed1998

A reverse triangular soleus flap based on small distal communicating arterial branches.

We report a 25-year-old woman who suffered traumatic damage to the medial malleolar area. Arteriography revealed a posterior tibial artery occlusion at the ankle. The predominant pattern of medial soleus vascularization was revealed during surgery. A reverse medial soleus flap including the posterior tibial pedicle was elevated. The lateral soleus was gradually elevated with it to ensure a full soleus base of the flap, resulting in a triangular shape. The flap survived completely. Both the triangular shape and the inclusion of the posterior tibial artery pedicle contributed the success of the flap by improving both the arterial supply and the venous drainage along the entire muscular flap.

Adult↗
PubMed1998

[Plantar dislocation of the tarso-metatarsal articulation (Lisfranc articulation). Apropos of a case].

Plantar fracture-dislocation of the tarso-metatarsal joint (Lisfranc plantar fracture-dislocation) is rather unusual. The authors described a case sustained in a 39 years old man injured in a motorcycle road traffic accident. Mechanism was recognized as plantar hyperflexion combined with an axial foot compression. Open reduction, and K-wires fixation were performed. An anatomical feature was restored. In an additional anatomical study on 8 cadavers, the plantar direction of a fracture-dislocation of the tarso-metatarsal joint was observed when the injury axis followed the scapho-cuneiform joint of the inner border of the foot and the cuboïdo-metatarsal joint on the lateral border, so that both tibialis muscles were fixed on the distal fragment. As tibialis posterior muscle is more powerful, the direction of the dislocation will be plantar. This type of injury is different from plantar fracture-dislocation of the tarso-metatarsal joint secondary to direct load bearing on the dorsum of the foot with severe skin and vessels injuries.

Accidents, Traffic↗
PubMed1996

Experimental prevention of free flap thrombosis. I: A model of free flap failure.

A model to evaluate the efficacy of therapies aimed at reducing the failure rate of microvascular free flaps was developed in the rat, inspired by earlier work on the rabbit ear by Ozbek et al. (Ann Plast Surg 32:474-477, 1994). It consisted in raising an epigastric groin flap on the femoral pedicle, while cutting the femoral artery, twisting it around the femoral vein, and resuturing it. Immediate patency was always seen, but 19 of 20 such anastomoses presented with thrombosis after 24 hours (15 venous and 4 mixed thromboses). Ten similar anastomoses performed without twisting did not result in thrombosis (P = 0.000000366). This model appears to be adequate for simulating free flap failure.

Anastomosis, Surgical↗
PubMed1996

Experimental prevention of free flap thrombosis. II: Normovolemic hemodilution for thrombosis prevention.

A microvascular free flap failure model consisting of raising an epigastric groin flap on the femoral pedicle, while cutting the femoral artery, twisting it around the femoral vein and resuturing it, has been previously described. As it was being evaluated, normovolemic hemodilution as a means to prevent thrombosis was simultaneously assessed using an additional experimental group. Twenty percent of the blood mass of each rat was taken and replaced with a hydroxyethyl starch solution immediately before surgery. Only 14 out of 20 anastomoses presented with thrombosis (13 venous and one mixed), as opposed to 19 out of 20 animals operated on without hemodilution (P< 0.05). Normovolemic hemodilution appears to be an effective method of reducing microvascular free flap failure.

Anastomosis, Surgical↗
PubMed1996

The distally based medial gastrocnemius flap: case report and anatomic study.

We describe a distally based flap of the medial head of the gastrocnemius, vascularized through a distal pedicle given off by the posterior tibial artery. A literature review showed that this flap and the distal pedicle had not been described previously as such, although several techniques have been used to cover a substance loss of the distal third of the leg using the medial gastrocnemius. The distal artery has a variable caliber, and it is not always possible to raise the flap. One patient has been operated on by this technique, and an anatomic study was performed showing that 9 of 30 legs had a distal pedicle larger than 1 mm, 14 had a pedicle smaller than 1 mm, and 7 had a microscopic pedicle too small to raise a flap.

Female↗
PubMed1995

Distal vascular pedicle-hemisoleus to tibial length ratio as a main predictive index in preoperative flap planning.

The management of severe compound tibial fractures is aimed at obtaining osseous consolidation, proper cutaneous and muscular cover, absence of infection and restoration of limb function. A knowledge of the cutaneous and muscular vascularisation allows the surgeons to use many flaps in a rational and predictable manner. One of the most commonly used flaps is the soleus muscular flap. This may be used as a proximally or distally based muscular flap and the use of a hemisoleus flap has also been described. A morphometric analysis of the relation between tibial length and soleus vascular pattern provides a simple and reliable method for planning this flap preoperatively. The study was performed on fresh and preserved cadavers.

Cadaver↗
PubMed1995

[Chronic compartment syndrome of the foot. A case report].

PURPOSE OF THE STUDY: The aim of this paper is to present an unusual localization of a chronic compartment syndrome concerning the medial compartment of the foot. It emphasizes surgical treatment, using a fasciotomy procedure. MATERIAL AND METHODS: A thirty year old man was examined for a painful right foot. Pain was situated on the medial plantar aspect of the foot. It appeared following 15 minutes of physical effort, especially after walking and running. It usually disappeared after a few minutes of rest and then, foot and lower leg examination were normal. The patient had comparative tissue pressure measurements at rest and after running, using a digital hand-held monitor (Stryker). A rest, the pressure was about 4 mmhg on both sides and it increased to 55 mmhg against 45 mmhg at the opposite side after exercise. It required more than 7 minutes vs. 30 seconds to return to their preexercise resting values. Thus a fasciotomy of the medial compartment was performed, using a medial approach. RESULTS: The patient had a good result at three months follow-up, recovering normal physical activity without any pain. DISCUSSION: The foot localization of an acute compartment syndrome has been recently described and it concerned only post-traumatic cases. The compartmental structure of the foot has been previously report. The chronic compartment syndrome of the lower leg was the reason for a pressure measurement study, at rest and following physical exercise; thus surgical fasciotomy was indicate when intracompartmental pressure rose above 30 mmHg in the presence of normal diastolic blood pressure, and particularly if delayed normalization of the pressure was greater than 5 minutes. The publications of foot pressure measurement are uncommon and they concerned only pressure at rest. In our observation, the profile of pressure of the patient and the result of fasciotomy, are in favour of chronic compartment syndrome. CONCLUSION: Chronic compartment syndromes require dynamic pressure measurements for an accurate diagnosis. Surgical fasciotomy may be sufficient to restore muscle function. We think this syndrome could happen in all anatomical compartmental structure when there is intensive use of muscles.

Adult↗
PubMed1994

Clinical, quantitative assessment of first tarsometatarsal mobility in the sagittal plane and its relation to hallux valgus deformity.

Today, bunion surgery is still controversial. Considering that a bunion deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrome of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a direct relationship between painful hallux valgus deformity and hypermobility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot where angulation of the first metatarsophalangeal joint is one of the consequences. The alignment of the metatarsal heads within the sagittal plane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignment in addition to the horizontal reposition of the metatarsal over the sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many hallux valgus deformities.

Adult↗
PubMed1994

[Dorsocommissural flaps. Apropos of a clinical case].

Dorsocommissural flaps are pedicled flaps with retrograde flow, anastomosed to the dorsolateral vessels of the proximal phalanx of one of the two fingers adjacent to the site of the commissure flap. The authors describe the anatomical basis and operating technique. A clinical case illustrates the simplicity and reliability of the technique. The indications for these flaps are digital skin defects either palmar involving the proximal phalanx and metacarpophalangeal joint, or dorsal involving the middle phalanx and the distal interphalangeal joint.

Adult↗