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D Guinard

Publications and source records attributed to D Guinard.

At least 19 recordsLinked to original sources
PubMed2006

[Distally based sural neurocutaneous flap: clinical experience and technical adaptations. Report of 60 cases].

The distally based sural neurocutaneous flap (Masquelet et al., 1992) has proved to be a useful technique for lower limb skin defect reconstruction. We report our experience in a 60 case series for the coverage of foot, ankle, and distal third of the leg with success in 58 cases and 2 failures. For one of these, a total necrosis occurred after a technical problem when harvesting the pedicle, while the second failure was due to a severe inferior limb vascular disability. In 14 cases, a partial venous congestion with a slight epidermolysis or a marginal necrosis was observed but it resolved without sequel. Seventeen patients presented with distal vascular impairment and/or neuropathies (i.e. diabetes mellitus, arteriosclerosis, vascular lesions) of the inferior limb and our experience favour a larger pedicle trimming than in normal cases to avoid venous congestion of the skin paddle. In 18 cases, when undermining of skin between the pivot-point and the defect site to be covered was too hazardous, we used an external pedicle either temporary and severed a few weeks after or skin grafted. This is a helpful mean when local condition of the skin to be undermined for pedicle tunnelling may interfere with the final issue. This one-stage simple technique, without major vascular sacrifice and with minor consequences at the donor site, is reliable for the distal third of the inferior limb, ankle, and dorsal foot aspect reconstruction, the heel-bearing zone excepted.

Adolescent↗
PubMed2004

["Opération Smile" missions in Mongolia].

We report our experience of plastic surgery of the face, limbs and burns in Mongolia. This country is three times as huge as France and has got 2,4 millions of inhabitants of whom almost one million live in the capital city Oulan-Baator, where sanitary and weather conditions are very tough for a large part of the population. The main observed and treated pathologies were sequellae of nerves and vessels lacerations, sequellae of complex hand injuries, sequellae of leg traumas, face, neck and limb burns, lips and palate clefts and pressure shores. The training of Mongol surgeons is far from good in the fields of skin coverage, digits reconstruction, treatment of nerve and vascular injuries and management of burns. Pedicled radial antebrachial, posterior interosseous, inguinal, sural, saphenous and lower limb muscular flaps were performed and taught. Microsurgery is still starting up. Thus we performed the first second toe transfer to reconstruct an amputated thumb. Some clinical cases are presented. This French-Mongolian cooperation should continue in order to match between both countries the knowledge and use of standard techniques in plastic surgery.

Adult↗
PubMed2004

[Foreign body reaction in osteoarthrosis of the trapeziometacarpal joint treated with trapezectomy and interposition of a Dacron "anchovy". A series of 5 cases].

Osteoarthritis of the trapeziometacarpal joint is a common pathology. Numerous surgical procedures exist without any of one of them showing an obvious superiority. In our practice, when the trapezium is not big enough to allow use of a Roseland total joint arthroplasty, we used a combination of trapeziectomy and Dacron anchovy interposition. This simple and fast technique gives results similar to others in terms of pain, joint motion and strength. It appeared to be a safe technique until 2000, where an abnormal complication appeared: five implants (11% of the 46 used between 2000 and 2002) displayed a foreign body reaction both clinical and radiological, and three patients underwent revision surgery for ablation of the implant. Histological analysis confirmed this adverse reaction in all of the cases. In view of the delay between surgery and reaction we expect new cases to appear, thereby increasing the current rate. In view of the lack of any other explanation for these findings, the authors have stopped using the Dacron implant, and have instead reverted to a classical tendon interposition.

Female↗
PubMed2003

[Extensor digitorum muscle flap: its position in ankle and foot coverage. Report of 15 cases].

The authors report their experience about a 15 cases series of ankle and foot soft tissues defects reconstruction with the extensor digitorum brevis flap which demonstrates its advantages. The flap was elevated in 9 cases on the tibial artery while the 6 others were raised on the distal dorsalis pedis artery with a retrograde flow. Healing was obtained for all cases with a complete resolution of septic problems for the 8 concerned cases. The outcome was uneventful for all but one which presented with a partial skin donor site secondary necrosis. No functional or trophic problems were noticed in other cases. Elevation of the extensor digitorum brevis flap is simple without note-worthy sequelaes. It is a reliable technique either for skin coverage or osteitis cure at level of the ankle. When raised with a retrograde arterial flow, it also appears as a useful alternative for the fore-foot reconstruction, location recognized difficult to treat by local means.

Adult↗
PubMed2003

[Anchovy dacron arthroplasty in the treatment of basal osteoarthritis of the thumb: long term results].

INTRODUCTION: Fifteen patients were treated for arthritis of the base of the thumb by trapieziumectomy and anchovy interposition using Dacron[symbol: see text]. The results are described. METHODS: The 15 patients were between 42- and 68-years-old at the time of operation. The mean postoperative follow-up was 3 years. Pain, pinch strength, opposition, opening of the first web space and height of the space formerly occupied by the trapezium were clinically and radiologically evaluated. RESULTS: Pain had completely disappeared in more than 80% of the patients. The mean post-surgical opposition was 8.9/10 (Kapandji score). The pinch strength and first web-space opening were improved, whereas the height of the trapezium site was always reduced by 25%. The only complication was one case of reflex sympathetic dystrophy: no case of foreign body reaction was reported. Eleven of the 15 patients were satisfied with the operation, and noted better thumb function in everyday life. DISCUSSION: The treatment of arthritis of the base of the thumb by means of trapieziumectomy and anchovy interposition is effective with respect to pain in all the studies previously published, whatever the technique used. Mobility is preserved, contrary to arthrodesis, and grip strength remains compatible with the patient's daily life. The choice of a synthetic anchovy such as Dacron[symbol: see text] allows a quicker operation and better than the ones involving sacrifice of a tendon at the wrist. Anchovy interposition remains the preferred alternative among other procedures in the treatment of basal osteoarthritis of the thumb.

Adult↗
PubMed2000

PS-100 and NF 70-200 double immunolabeling for human digital skin meissner corpuscle 3D imaging.

For detailed study of complex structures such as corpuscular mechanoreceptors, confocal microscopy can be used with multiple immunolabeling that identifies specifically different subcomponents. In addition, anatomic interpretation is enhanced by three-dimensional reconstruction. Confocal laser micrographs, reconstructed from serial images 1 microm thick of human skin Meissner corpuscles simultaneously immunostained for neurofilaments (NF 70-200) and protein S-100 (PS-100), clearly reveal the complex 3D relationship between Schwann-related lamellar cells immunoreactive for PS-100 and the nerve fibers marked by NF 70-200. The nerve fiber, after branching into the corpuscle, divides into several ramifications, presenting discoidal expansions and flattened fringed sections. The mean nerve diameter was 4 microm +/- 1 (2-5 microm) and the mean size of the discoidal expansions was 15 microm +/- 1 (7-30 microm). Corpuscle size varied from 30-140 +/- 1 microm in length and from 20-60 +/- 1 microm in diameter. This study confirms the presence of neural discoidal areas in Meissner's corpuscles, which are probably involved to some extent with the transduction process. Despite the accuracy of immunolabeling and imaging, an extracorpuscular neural network was never observed in the vicinity of corpuscles, thus giving doubt as to their existence. (J Histochem Cytochem 48:295-302, 2000)

Adult↗
PubMed1999

The Mantero flexor tendon repair in zone 1.

Mantero and colleagues have reported a modification of the Bunnell pull-out method for the repair of zone 1 flexor digitorum profundus (FDP) lacerations that allows active postoperative mobilization. We report a series of 24 FDP lesions in 20 adult patients treated with this technique. The mean duration of the rehabilitation regimen, which was followed by all patients, was 4.2 months. Functional assessment using Strickland's criteria demonstrated 23 excellent to good results and one poor due to a septic rupture. Nineteen of the 20 patients were satisfied with treatment and all but one of the patients returned to work within an average of 2.6 months after operation. In comparison to other zone 1 repair methods with active mobilization regimens, the Mantero technique gives better functional outcomes and appears to be more reliable.

Adolescent↗
PubMed1998

Merkel complexes of human digital skin: three-dimensional imaging with confocal laser microscopy and double immunofluorescence.

Three-dimensional (3-D) reconstruction of images provided by confocal scanning laser microscopy (CSLM) is a powerful tool in a morpho-functional approach to cutaneous innervation studies. To investigate mechanoreceptors in the hand, a study of Merkel complexes was performed in human finger. A double fluorescent-conjugated immunolabeling with antibodies against neurofilament (NF 200) and cytokeratin (CK 20) on floating, thick cutaneous samples (80 to 100 microm), was used. After acquisition of serial optical planes by CSLM, reconstruction was performed with 3-D reconstruction software tools. Merkel cells were clearly labeled with CK 20, whereas nerve components were only NF 200 reactive. The cells, localized on the basal lamina of the epidermis, were usually arranged in clusters of five to eight cells. Each cell was connected to a nerve process ramification originating from a unique fiber. Quantitative data, compiled from a sample of 25 Merkel complexes, gave a mean cell diameter of 13 +/- 1 microm and a mean nerve fiber size of 3 +/- 1 microm. Surface measurements were done on a single reconstructed cluster with a mean and standard error which only refers to the optical 3-D resolution. It gives a surface of 12 +/- 1 microm2 for the contact zone between cell and nerve fiber and a cluster area of about 500 microm2. The great precision of reconstructed images provides a detailed analysis of spatial relationships between abutting nerve fibers and Merkel cells. Data interpretation is improved with complementary ultrastructural and physiological studies results, and this allows an accurate investigation of cutaneous sensory endings.

Antibodies↗
PubMed1997

Pins and Rubbers Traction System.

The Pins and Rubbers Traction System (PRTS) is a mobile frame created with wires to support elastic traction, which produces a ligamentotaxis effect in the same direction and of the same intensity whatever the position of the joint. This technique has been used in 11 cases of complex PIP joint fractures with eight excellent results. The advantages are simplicity, adaptability, the possibility of immediate mobilization, reasonable cost and relatively small bulk.

Adolescent↗
PubMed1996

[Neurocutaneous flap of the external saphenous nerve. A safe, easy and fast procedure for covering loss of substances of the ankle. A propos of 5 cases].

The distally based sural neurocutaneous flap is another procedure to cover the heel. It is an island flap based on the vascular axis of the sural nerve in the lower two thirds of the leg. The nerve is included in the pedicle after proximal section (it is therefore not a sensitive flap). The size of the flap, length of the pedicle, absence of vascular sacrifice, the simple procedure, and minor consequences at the donor site led us to use this technique five time over on period of four months with success.

Adult↗
PubMed1994

[Fractures and luxations of the thumb].

The integrity of the first carpometacarpal column determines the mobility of the thumb in space and thus opposition, a fundamental function of the human hand. Fractures and dislocations of this architecture can jeopardize its function. Joint lesions lead to instability or incongruity and subsequent post-traumatic stiffening arthrosis. Diaphyseal fractures can put out of axis or lead to abnormal rotation which impair the flexion and overall function of the thumb. Great attention should therefore be given to the anatomical reconstruction of these lesions. Open, unstable joint or periosteal fractures should be surgically reduced and a rigid fixation should be used. Dislocations require emergency treatment and in case of postreduction instability should be immobilized.

Emergencies↗
PubMed1994

[A comparative study of the "Levame" type extension splint and the "Low Profile" type extension splint: impact on therapeutic indications].

The most widely used dynamic extension systems, both to straighten the digital flexion retractions as well as to ensure directed mobilization after surgical repair of extensor tendons, are the so-called "Levame" and "Low Profile" splints. This study analysed the application of forces for these two types of extension splints, the directional constraints which they impose and freedom of joint movement which they allow in order to more clearly define the type of motorization to be used as a function of the most frequent indications.

Equipment Design↗
PubMed1994

[Restoration of opposition using the extensor pollicis longus. Apropos of 8 cases reviewed after 11 years].

Moutet and coll. had studied in 1986 a series of 16 cases of restoration of thumb opposition by extensor pollicis longus transfer onto abductor pollicis brevis through the inter osseous membrane. Eleven years follow-up revision of 8 of those 16 patients was performed by the authors. Indication of transfer was traumatic median nerve isolated palsy or associated to ulnar nerve palsy. Objective and subjective analysed parameters allowed to check the evolution of the transfer and to justify its indications. No transfer retraction has been noted in long term follow-up. The side effects of its removal (thumb retropulsion and MP extension defects) have minimum functional consequences. The opposition has been restored at the time of thenarians recovery and as well, each time the palsy was going on. In the cases where the thenarians recovered, the transfer became an antepulsion supply. The authors suggest to perform an opposition transfer, each time it is technically possible, in severe median nerve lesions, at the time of emergency operation.

Adolescent↗
PubMed1994

[A new titanium-carbon finger joint implant. Apropos of 15 initial cases].

Arthroplasty of the MP and PIP joint remains a therapeutic challenge for the hand surgeon. The poor results of the currently available implants are due to their mechanical conception (non strained) or their material (silicone causing instability, ruptures and silicone synovitis). The authors present the preliminary results of a new digital articular implant (IAD). It is a strained implant with a rigid hinge allowing 105 degrees of range of movement (0 degree to 105 degrees). Three sizes are available and very soon four. The intramedullary stems are in titanium alloy (TA6V) and the gliding surfaces in pyrolytic carbon. This association allows solidity, endurance, excellent gliding and no wear debris. 15 implants were evaluated (13 PIP and 2 MP joints) with a follow-up from 4 to 1 year. A painless range of motion were restored in 11 cases and 4 articulations were only lightly painful during motion requiring strength and at the end of the movement. The gain of the range of movement was 50 degrees always in a useful sector. The grasp was 60% better in post than in pre operative conditions. No infection was found. It is only the beginning of this implant but the indications seem to be good for all the articular destructions of the digital joints what ever was the aetiology (traumatic, infection or rheumatoid arthritis).

Adult↗
PubMed1994

[A proposal for a functional evaluation record for the hand].

Proposition of a new evaluation method included an analytic cotation, a functional cotation, and a cosmetic cotation. Use is speeded by the suppression of all kind of measure instrument and facilited by pictures. Application to the corporal damage evaluation.

Disability Evaluation↗