Biomedical subjects
Publications and source records attributed to A Gilbert.
This article presents the first series with long-term results of a large number of patients. As a result, it is difficult to compare these results with anything but spontaneous recovery. In most cases, the end result after surgical treatment will be better than spontaneous recovery.
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Satisfactory replacement of skin defects over the lower leg remains a difficult problem. Various forms of coverage, including, local rotation flaps, muscle flaps, and fascial and free flaps, have their specific indications and inherent disadvantages. In this work, a new axial skin flap based on perforating vessels in the territory of the anterior tibial artery is described. A series of 50 lower leg dissections was carried out in 25 fresh cadavers after latex injection into the femoral artery. Detailed studies of the cutaneous distribution of the anterior tibial artery showed that three main arteries perfuse the anterior lateral portion of the lower leg. The superior lateral peroneal artery and the inferior lateral peroneal artery interseptal cutaneous perforators arise at an average of 25.6 and 17.2 cm from the lateral malleolus, respectively. The superior lateral peroneal artery was present in 100 percent of the specimens, whereas the inferior lateral peroneal artery was present in 70 percent of the specimens. In their course, they give several muscular branches to the peroneus longus and brevis prior to perforating the fascia and arborizing in the subcutaneous tissues of the anterolateral portion of the leg. The average external diameter was 1.6 cm for the superior and 1.4 cm for the inferior lateral peroneal artery. The superficial peroneal nerve accessory artery is the third artery which contributes to the skin of the lower leg. It arises from the superior lateral peroneal artery in 30 percent of cases, from the inferior lateral peroneal artery in 40 percent, and from both in 30 percent. The artery runs along with the superficial peroneal nerve and gives several cutaneous perforators along its descending course. Several cutaneous axial flaps can be fashioned around this anatomy. The operative technique along with demonstrative clinical cases is presented followed by pertinent discussion.
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In the light of 10 years experience with more than 200 operative cases, the author presents the various operative techniques for the cover of skin loss in the lower limb. The different techniques are reviewed: muscle rotation flaps, myocutaneous flaps, pure cutaneous flaps, neurovascular island flaps and free vascular flaps. These procedures are described in detail, particularly those most often used. Indications are considered in terms of levels. At the present time, the author's preference is for muscle rotation or cutaneous flaps; his use of free vascular flaps has much diminished in recent years. The indications also depend on the patient's age, the condition of his joints and the state of his vessels.
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Macrodystrophia lipomatosa is the hypertrophy of a limb or of a limb-segment due to fatty infiltration. X-ray examination of the soft tissues which reveals the presence of fat, most often allows the easy distinction of this disorder from other causes of localized hypertrophy.
The objectives of this work were to evaluate, in the light of experimental results, the growth potential of vascularized fertile epiphyseal bone transplants transferred with their surrounding soft tissues in children. Thirty-one toe transfers were available for analysis from the series performed in Trousseau hospital (Paris). The results were reviewed with the unique goal of the study of growth. Transferred toes grow in an almost identical fashion to normal toes. The slightly diminished growth difference found was in accordance with experimental results. Criteria for determining the growth of these transfers must be very strict from a clinical as well as from a radiological point of view. The possibility of transfer of an isolated epiphyseal growth cartilage implies previous elaborate studies of the anatomy of epiphyseal vascularity as well as the physiology of intraosseous blood flow. Restoration of this potential for growth in children should be attempted as early as possible.
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.
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From 1977 through 1984, the author transferred 49 toes in 38 patients to treat congenital defects of the hand. Eleven patients had successful transfer of two toes from different feet, with a six-month interval between operations. There was one failure in a 16-month-old infant with finger aplasia. On the basis of this experience, the author has refined his indications and timing, which are as precise and well defined as the technique.
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.
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.
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