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Biomedical subjects

A C Masquelet

Publications and source records attributed to A C Masquelet.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Forum: cover flaps of the upper limb. In practice: indications of pedicled flaps of the upper limb].

The author analyses the historical development and disadvantages of pedicled island flaps of the upper limb. The various procedures for skin cover of the upper limb are described region by region: shoulder, arm, elbow, forearm, wrist, hand and fingers. The large number of these procedures means that the reconstructive surgeon would have to be able to master all techniques and indications. Adopting an eclectic approach, the author proposes two main flaps: the latissimus dorsi muscle to cover the proximal region of the upper limb and the pedicled inguinal flap for the distal upper limb.

Arm Injuries↗
PubMed1993

Anatomic basis of the physiopathology of the epicondylalgias: a study of the deep branch of the radial nerve.

Compression of the deep branch of the radial n. during its passage through Fröhse's arcade in the supinator m. is one of the classical explanations advanced for epicondylalgia. The object of this study was to define the anatomy of the deep branch of the radial n. from its origin up to the origin of the branches to the lateral epicondylar mm. 34 upper limbs were dissected and three segments of the deep branch of the radial n. were distinguished: segment I, from its origin to its entry into the supinator m.; segment II, corresponding to its passage through the supinator m.; and segment III, extending from its exit from the supinator m. to the origin of the nn. to the lateral epicondylar mm. The lengths of these three segments were defined, as well as the level of division of the radial n. in relation to the joint-line, the thickness of the arcade of the supinator m., and the number of nerve branches to the supinator m. It was found that segment III is closely related to the radial head, around which it winds in supination and extension. The three nerve segments thus defined were studied separately microscopically for evidence of lesions. The results were as follows. Segment I: absence of any marked histologic lesions; segment II: marked fibrous thickening of the perineurium and the interstitial connective tissue, replacing certain nerve fibers; segment III: persistence of moderate interstitial fibrosis. These findings appeared constant in all the specimens examined. These results indicate that the deep branch of the radial n. is most affected during its passage through the supinator m.(ABSTRACT TRUNCATED AT 250 WORDS)

Forearm↗
PubMed1993

The isolated scapho-trapezio-trapezoid ligament injury. Diagnosis and surgical treatment in four cases.

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament. Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scapho-trapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair. The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.

Humans↗
PubMed1992

Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg.

An anatomic study performed on 64 fresh injected legs has shown the role of the vascular axis that follows the superficial sensitive nerves in supplying the skin. Three nerves were studied: the saphenous nerve, the superficial peroneal nerve, and the sural nerve. Conclusions are the same for the three nerves: The vascular axis, which can be either a true artery or an interlacing network, ensures the vascularization of the nerves, gives off several cutaneous branches in the suprafascial course of the nerve, and anastomoses with the septocutaneous arteries issuing from a deep main vessel. The superficial nerves that course the leg can therefore be considered as vascular relays owing to their neurocutaneous arteries. The concept of a neuroskin island flap has been developed and applied to six clinical cases for coverage of some specific areas of the knee and of the lower part of the limb.

Adult↗
PubMed1991

[Soft tissue preservation and reconstruction in non-supporting foot parts].

The foot has two skin surfaces which differ on a morphological and functional basis. The plantar skin is a highly specialized organ which has a dash-pot-like effect in weight bearing. The skin which does not participate in weight bearing covers tendons and a very rich syndesmotic complex. The internal soft tissue is segmented in tiny compartments and therefore ist not extensible. The skin and the rather thin subcutaneous layer are not extensible either because of the proximity and the rigidity of the underlying structures. In consequence, trauma to the soft tissue of the foot may cause compartment syndromes and skin defects, or secondary unstable scars which impede function. Compartment syndromes must be recognized early and treated by immediate release. Fresh skin defects need early coverage when tendons and joints are exposed. There is a variety of local flaps which are evenly good for replacement of retracting scars.

Foot Injuries↗
PubMed1991

[Surgical reconstruction of post-traumatic tissue loss of the weight-bearing sole of the foot].

The repair of the weight bearing zones of the foot is a difficult problem for which an ideal solution does not exist. The contribution of pedicled flaps and free flaps allows it nevertheless to obtain reconstructions of good quality, which are however prone to mechanical complications. The pedicled flaps most commonly used are the instep island flap, the lateral supra-malleolar flap and the cross-leg flap. Among the free flaps figure the latissimus dorsi flap, the forearm flap and the free scapular flap. The sensitivity of the flap does not seem to be a decisive advantage if the receptor region is normally innervated and of good trophic quality. On the contrary, a sensible flap becomes necessary on a foot with neurological complications or extensive skin complications. About 15 years ago, the introduction of technical procedures on the basis of vascularised flaps has considerably modified the indications for the treatment of substance losses of the foot in the weight bearing zone. It is advisable from the beginning to distinguish radically between feet with normal sensibility and feet which are insensible owing to peripheral nerve lesions. We have excluded on principle those cases where the nerve lesion is of congenital origin or secondary to a nontraumatic affection. We will deal successively with the problems due to the localisation of the substance loss, the possible surgical techniques, the indications, and the complications.

Amputation, Surgical↗
PubMed1991

[Free-flap coverage technique with double vascular bypass in the lower limb].

In thirteen patients, the repair of a soft tissue defect of the lower limb required a free tissue transfer revascularized by microvascular grafts. The indication of vascular grafting was either the absence of vessels or inadequate recipient vessels. Proximal anastomoses were performed on the femoral artery and the femoral vein or the long saphenous vein. All the transfers were done in one stage procedure. In two cases, a transitory arteriovenous shunt was established. Three flaps out of thirteen have been lost by thrombosis. The discussion concerns the causes of the failures and the indication of the establishment of a transitory or a temporary arterioveinous shunt prior to free flap transfer.

Adult↗
PubMed1990

Anatomic basis of a dorso-commissural flap from the 2nd, 3rd and 4th intermetacarpal spaces.

This study relates to an island skin-flap constructed on the dorsal aspect of the hand, between the heads of the 2nd, 3rd, 4th and 5th metacarpals. The vascular pedicle consists of the subcutaneous fatty tissue of the dorsal aspect of the proximal phalanx. This fatty tissue is richly vascularized by the dorsal branches of the proper palmar digital artery and by the periarticular circle of the proximal interphalangeal joint. The point of rotation of the flap is situated at the level of the proximal interphalangeal joint. The length of the pedicle allows the skin flap to cover losses of substance of the dorsal aspect of the middle and distal phalanges. Its chief advantage is that it does not sacrifice the proper palmar digital artery.

Blood Vessels↗
PubMed1990

Periosteal flaps: anatomical bases of sites of elevation.

An anatomical study made in 25 injected fresh subjects made it possible to map out the periosteal flaps capable of being raised on the limbs. The preferred donor sites are the distal third of the humerus, the iliac fossa and the distal third of the femur. At the last 2 sites composite osteo-periosteal or musculo-osteo-periosteal flaps can be raised. These technical possibilities illustrate the importance of experimental studies which have shown the osteogenic capacity of grafts of vascularized periosteum.

Femur↗
PubMed1990

Vascularized periosteum associated with cancellous bone graft: an experimental study.

The association of a vascularized periosteal flap with a cancellous bone graft was studied on a group of 20 Wistar rats. Ten rats were sacrificed at 6 weeks and seven at 12 weeks (three died prematurely). The behavior of the cancellous bone graft buried in striated muscle and the osteogenic capacity of a simple vascularized periosteal flap also were observed on the same animals. Results of the study are as follows: In 14 of 17 animals, a vascularized periosteal flap wrapped around a cancellous bone graft resulted in new cortical bone formation with little resorption of the initial cancellous graft. A vascularized musculoperiosteal flap has produced a small amount of new compact bone only in 4 of 17 animals. A cancellous bone graft buried into well-vascularized muscle tissue was resorbed (15 cases) or necrotic (2 cases) at 12 weeks. In conclusion, the association of a vascularized periosteal flap and cancellous bone is a better means to produce compact bone than a vascularized periosteal flap alone or an isolated cancellous bone graft.

Animals↗
PubMed1990

The medialis pedis flap: a new fasciocutaneous flap.

An anatomic study (30 fresh specimens dissected) and clinical experience (5 patients) have shown the reliability of a fasciocutaneous flap raised from the medial side of the foot. The artery that supplies the flap is issued from the medial plantar artery. The arch of rotation allows one to cover some specific areas, such as the medial malleolus, posterior aspect of the heel, and distal insertion of Achilles tendon.

Adolescent↗
PubMed1989

The reverse flow medial knee osteoperiosteal flap for skeletal reconstruction of the leg. Description and anatomical basis.

A new, pedicled, reverse flow osteoperiosteal flap based on 2 branches of the descending genicular a. is presented. Both a periosteal and osteoperiosteal flap can be raised at the distal end of the femur and, in favourable cases (64% of the dissections), transported as far as the middle third of the leg. In all other cases the proximal third of the tibia can be reached. Composite musculo-osteoperiosteal flaps can also be raised, including the articularis genus m. Clinical applications may include the treatment of nonunions, reconstruction of segmental tibial defects and bone revascularisation in aseptic necrosis about the knee joint.

Aged↗
PubMed1989

Bourgery's artery: anatomic basis for a new cutaneous skin flap (21.06.88).

Bourgery's artery, the first branch of the popliteal a., delivers further branches to the vastus lateralis and biceps femoris m., by its terminal cutaneous branch, supplies a large territory of the external surface of the thigh. This area can be mobilized as a skin flap pedicle to cover tissue losses in the knee area.

Burns↗