Biomedical subjects
Publications and source records attributed to A C Masquelet.
The clinical examination of the wrist allows an accurate orientation of the diagnostic. The precise localization of the pain is essential in order to identify the injured intracarpal structure. Stress tests are designed to reproduce painful mobilisation and to reveal an instability. Clinical examination of the wrist is a pre requisite to guide radiological investigations.
The vascularization of the extensor digitorum brevis is ensured on its deep aspect by branches of the anterior tibial artery, but also by a lateral arterial arch anastomosing with these branches. The lateral vascular arch of the extensor digitorum brevis was constantly found in 37 anatomic specimens: 17 formolized and 20 fresh. This arch derives from the perforating peroneal branch, the terminal anterior branch of the peroneal artery. Its variable caliber, assessed by arteriography of the foot, seemed adequate for the peroneal artery to serve as a pedicle for the extensor digitorum brevis without interruption of the anterior-tibial axis.
The length, caliber and course of the perforating branch of the peroneal artery are described following examination of both feet of 20 cadavers. This terminal branch of the peroneal artery has a constant, predictable course and may normally be sacrificed without any vascular compromise in the foot. It has great surgical potential at it is strategically situated so that it can act as a vascular pedicle for a large cutaneous flap situated on the lower lateral leg, with an axis of rotation centered at the midtarsal joint. This has been used by the senior author (AC Masquelet) as a pedicle flap and as an island flap for reconstruction of the foot and ankle with satisfying results.
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Injuries of the distal phalanx of the digits in children may lead to various lesions. The association of avulsion of the nail with an epiphyseal separation is not uncommon. This is in fact an open fracture, with the risk of infection of the flexor digitorum tendon sheath. The authors report such an observation and discuss the mechanism and treatment.
An anatomic study (40 fresh dissected specimens) and clinical experience (14 patients) have shown the reliability of a skin flap designed on the lower third of the lateral aspect of the leg. It is supplied by a cutaneous branch from the perforating branch of the peroneal artery. This perforating branch continues distally deep to the fascia along the anterior ankle and into the foot. This can be used as a reversed pedicle, giving the flap an arc of rotation that allows coverage of the dorsal, lateral, and plantar aspects of the foot, the posterior heel, and the lower medial portion of the leg.
The external supramalleolar flap is a mixed cutaneoaponeurotic flap removed from the external surface of lower part of leg and with, as its principal vascular pedicle, the anterior perforating branch of the peroneal artery. The flap can be used in two ways: as a rotation flap with distal cutaneous hinge allowing lover third of internal surface of leg and instep to be covered, or as a retrograde flux island flap by anastomosis of perforating artery to arteries of foot. The latter procedure is of interest in that it permits covering of loss of distal substance of foot in the dorsal or plantar region. Results of use of this method in 35 patients situate the place of the external supramalleolar flap in the techniques available for lower limb repair.
Skin flaps for coverage of skin defects in orthopaedic surgery have been more and more used in recent years. However all the authors are not in agreement concerning the pattern of vascularization of these flaps. Two problems should be studied separately: the vascularization of the skin in situ which is already rather well known and the vascularization and the pattern of vascularization of the flaps after transfer. Several models of flaps, that is axial, septal or musculo-cutaneous, are based on the origin of skin vascularization, that is by long running arteries, septal arterioles or indirectly by arteries coming from muscles. Therefore a flap must be determined by its type of vascularization, its shape and its composition. Surgical rules concerning skin incisions and deep structures approaches are recalled.
There are many classifications for paralyses of the upper limbs. In this article, the authors present a classification system which may be useful for the surgeon when analyzing the indications for reconstructive surgery. This classification system correlates the functional deficits that exist with nerve lesions at different levels, and thus helps the surgeon to establish a list of the deficits and of the functions to be restored. This functional balance should be used as a guide for surgical rehabilitation.
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A number of techniques have been developed to prevent or treat painful neuromas in the hand. Intra-osseous implantation of the ends of the nerves, as described by Boldrey in 1943, has only been extensively applied over recent years. Between 1977 and 1983, we used this technique to treat twenty eight cases of painful neuromas in a group of twenty patients. All but two of the patients were permanently improved and the best results were obtained in neuromas of the anterior branch of the radial nerve.
The posterior interosseous flap is a new fasciocutaneous flap designed on the postero-lateral aspect of the forearm. The anatomical study was carried on seventy dissections of fresh specimens. The flap is supplied by the posterior interosseous artery which delivers several cutaneous branches. The posterior interosseous flap can be used as a proximally based pedicled flap or as a distally based one thanks to the anastomosis at the level of the wrist, with the anterior interosseous artery and with the dorsal arch of the carpus. The flap can be employed as a fascial flap. Eight clinical cases have been performed to cover soft tissues defects of elbow, wrist and hand.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors present a study of the surgical anatomy of the posterior interosseous artery (PIA) in 70 cases to establish the anatomic basis of a new forearm fascio-cutaneous flap, the posterior interosseous flap which has been described by one of the authors (AC Masquelet). The PIA was verified in every case. Its course corresponds to a line drawn from the lateral epicondyle of the humerus to the head of the ulna, i.e. to the septum between the extensor carpi ulnaris and extensor digiti minimi proprius muscles. The artery, whose average caliber is 1.7 mm, gives off 7 to 14 cutaneous branches in its course. The point of emergence of the artery in the posterior aspect of the forearm corresponds to the junction between the upper and middle thirds of the line from the epicondyle and the ulnar head. The PIA anastomoses with the anterior interosseous artery and the dorsal carpal network in 98.6% of cases. The artery remains closely related to the deep branch of the radial nerve and is crossed by the branches of this nerve to the extensor carpi ulnaris muscle. The cutaneous distribution of the PIA extends from elbow to wrist, centered on the epicondylarulnar line, with an average breadth of 5 cm. Twelve operations have already been performed using the posterior interosseous flap, 2 with a direct pedicle and 10 with a retrograde pedicle, and all survived completely.
The aim of this study, based upon anatomical and electrophysiological evaluation, was to identify the relationship between the morphology and physiology of the first dorsal interosseous muscle of the hand, which should be distinguished from the other dorsal interosseous muscles of the hand. Its morphology, distal attachments and physiology have been subject of numerous studies yielding conflicting results. The study reported herein was made on the basis of anatomical and electrophysiological investigation. Most of the dissections (20/34) were made on fresh specimens. Results of this study confirm the existence of the deep and superficial heads of the 1st dorsal interosseous muscle. The muscle is attached distally to the palmar plate of the metacarpophalangeal joint, the lateral tubercle of the base of the proximal phalanx of the index and the interosseous hood. Conversely, the muscle did not show any attachment to the oblique radial wing of the extensor apparatus in our dissections. The deep head of the muscle causes mainly flexion pinch between thumb and index superficial head abduction. Within the complex physiology of the various types of apposition of thumb and index, the dorsal interosseous muscle acts as a stabilizer. The results of electrophysiological study confirmed most of the interpretations deduced from morphological investigation.