Biomedical subjects
Publications and source records attributed to A C Masquelet.
An osteoid osteoma at the elbow is uncommon. We report a case of such a tumor at the coronoid process, without involvement of the joint. The tumor was excised through a posteromedial approach to the elbow, with release of the flexor carpi ulnaris muscle.
A case of volar dislocation involving the four ulnar metacarpals treated by open reduction and fixation with Kirschner wires is reported. A review of the literature leads the authors to suggest several pathogenic hypotheses. The mechanism may be direct or indirect according to whether the trauma is sustained on the metacarpal heads or on the bases of the metacarpals. Emergency treatment by open reduction and fixation usually provides excellent results.
Hypertrophic scars are the most frequent sequelae of severe burns, their prevention involving the early and continuous use of a compressive orthesis. However, their efficacy is often limited in the facial region because of the contours of this area of body. A siliconized facial mask worn under the compressive dressing considerably improves esthetic and functional results by equalizing distribution of pressure forces. The technique employed for preparation of this siliconized mask is described.
An original technique for intrabuccal fixation of orotracheal intubation catheters is described. Applicable for extensive external facial operations only, this procedure allows operation to be performed under conditions of comfort and safety superior to conventional methods using sparadrap and cordonnet. Strict adherence to the technique is necessary to avoid complications.
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A better knowledge of the leg skin blood supply has recently revived interest in the cross-leg technique for skin grafts. It is now possible to delineate on each leg two flaps that contain arteries and veins. The internal saphenous flap, taken on the internal aspect of the leg is fed by the cutaneous branch of the greater anastomotic artery, satellite of the internal saphenous nerve, while the external saphenous flap, located on the postero-external aspect of the leg, is fed by 2 cutaneous branches of the popliteal artery or gemellar arteries. The length to width ratio of these flaps varies from 3 to 4, which is both safe and reliable and provides for supple handling of the pedicles and increased patient's comfort.
Eschars located in the sacral and ischiatic areas raise problems of recovering when much tissue has been lost. The usual techniques, such as dermoepidermal grafts or local skin flaps, are difficult to perform and have a high failure rate. In contrast, musculo-cutaneous flaps are excellent both to fill and to cover the raw areas. Three types of flap have been used successfully by the authors in 12 consecutive patients, some of whom had paraplegia. Two of them involve the greatest gluteal muscle which is divided into two heads according to blood supply. The "butterfly" flap uses the upper heads of the two muscles, on either side of the midline, with the corresponding skin territories ; it is most useful to cover wide sacral areas. In the "pendular" flap, the lower head of one of the greatest gluteal muscles is mobilized to cover a moderate loss of tissue in the ischiatic area. Finally, the "kite" flap concept is based on bringing up the ischio-crural muscles to cover wide ischiatic eschars.
The posterior brachial flap is a vascularized skin flap originally developed by AC Masquelet in 1982. Anatomical study in 37 non embalmed cadavers demonstrated the value of this flap which is taken from the posterior surface of the arm. The artery of the flap originates from the brachial or deep brachial artery and was present in all 37 subjects studied. This artery traverses the aponeurosis of the triceps brachii near the termination of the tendon of the teres major. The pedicle showed a mean length of 4.4 cm and mean diameter of 1.5 mm thus allowing satisfactory microsurgical anastomosis to be done. The mean length of the artery in the subcutaneous tissue was 11 cm. Venous return is via satellite veins. Sensory innervation of the flap is supplied by the nervus cutaneous brachii posterior, the first branch of the radial nerve. The posterior brachial flap can be used as a free flap. Owing to its innervation, this flap is appropriate for repair of defects in zones requiring sensory innervation. This flap can also be used as a pedicle flap for cutaneous repair of the axilla.
The adductor magnus tendon and its insertion (cortical and cancellous bone) are vascularized by the articular branch of the descending genicular artery of the knee. Anatomic findings support a reliable transfer of vascularized bone or tendon. Some applications are restoration of the cruciate ligament of the knee, free vascularized bone transfer for treatment of avascular bone necrosis or post-traumatic pseudoarthrosis, and pedicled tendon transfer to reinforce repairs of the medial ligament of the knee.
A new cutaneous free flap is described on the posterior side of the arm. This flap is supplied by an unnamed artery from the humeral artery or the deep humeral artery. It is drained by the accompanying venae comitantes. Its nerve supply is from the radial nerve. Its advantage is a flexible skin and a primary closure of the donor site if the flap does not exceed 7 cm in width. The principal disadvantage is its modest measurements. This flap has been employed in five cases for reconstruction of hand and foot. All flaps survived despite a necessary revision of an arterial anastomosis in one case and a partial necrosis in another case. Results are satisfactory, especially in restoration of weight-bearing areas of the foot.
Fifty children had been treated for recent injuries to the flexor tendons. In them, 98 lesions, of which half were at the palm or the wrist and the other half in areas I or II of the fingers. All the divided tendons were primarily repaired, using a combination of a frame suture and two casting sutures. The results seemed to be better when post-operative mobilisation using Kleinert's technique was used. The overall results were better than those obtained in adults. The indications for secondary tenolysis were infrequent when primary suture was correctly made and spontaneous improvement was noted for up to a year.
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The authors report a case of haemorrhage due to cephalexin therapy. The bleeding started after an orthopedic operation in a patient without renal failure, receiving 3 g/day of cephalexin. Platelet function was very abnormal at the time of the haemorrhage with a bleeding time of over 20 minutes, which returned to normal when treatment was stopped. This case seems to be similar to other reports of haemorrhages during treatment with other beta-lactams.
The plantar flap is a sensory skin flap fed by the lateral plantar artery. It is taken from the instep of the plantar vault and therefore has no functional consequences. It is particularly useful to resurface heel defects.
The anatomy of the radial forearm flap initially described by Chinese authors was studied in 25 dissections. The reliability of this flap, regardless of the incisional sites used, was demonstrated by the constant presence of several arterioles supplying the cutaneous tissue. The comparison of clinical experience and anatomical data led to the identification of the different methods and the advantages and disadvantages of the Chinese forearm flap.
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