Biomedical subjects

D Guinard

Publications and source records attributed to D Guinard.

29 records · Page 2Linked to original sources

PubMed1994

[Use of an implanted electrode for rehabilitation after tenolysis of the flexor tendons].

The electric stimulation is widely used in flexor tenolysis rehabilitation by the authors. Since 1983 implantable electrodes were used during the operative procedure. Actually they gave better access to the deep muscles (Flexor Profundus of the index), better specificity, less dysesthesia of the skin. Further more they allowed to tests the quality of the tenolysis without wrist incision. This procedure gave 76% of good or very good results over 25 finders in 20 patients. The results were especially good for the index finger which is usually unable to be stimulated by the surface electrodes and for the fingers badly damaged. In this type of situation prognostic was getting better (70% of good and very good results).

Adolescent↗

PubMed1993

[Subcutaneous rupture of long finger flexor pulleys in rock climbers. 12 case reports].

Rock climbing generates a new type of microtraumatic, stress pathology involving all of the osteoarticular chain of the upper limb. The hand is the site of specific lesions: pulley ruptures (A2) are the most frequent. 12 top-level climbers (7a and above) were reviewed out of a series of 23 cases. In 7 cases, the ring finger was affected and in 5 cases the middle finger was affected. All cases were treated by rest and protection of the A22 pulley with an external rigid ring. Progressive return of climbing was allowed after the 45th day. The effects on the level of performance, residual pain and its consequences, and on associated lesions of the upper limb were investigated. 8/12 patients regained at least their previous level of performance and 6/12 no longer experienced any pain. 5/12 patients experienced minor pain which did not affect their level of performance. One patient had to stop top-level climbing because of persistent pain. Protection of the pulley, possibly combined with syndactylisation and complete rest, not only from sports activities, for at least 45 days are the best way of ensuring a satisfactory functional result in these particularly demanding subjects. Physiotherapy and non-steroidal anti-inflammatory treatment can also be combined.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1993

[Synthetic ligament reconstruction of the thumb metacarpophalangeal joint. 21 cases].

Since 1984, the authors have performed ligamentoplasties of the metacarpophalangeal (MP) joint of the thumb with Dacron mesh. A series of 21 cases is reviewed and tested clinically with a mean follow-up of 34 months. The MP joint remained stable. Loss of flexion of the MP joint was 30% of the healthy side. The mobility of the interphalangeal joint remained normal. Opposition ranged between 8 and 10/10 for 20 of the 21 patients. The mean overall reduction in strength was 30% on the dominant side and 20% of the non-dominant side. Apart from two failures by arthrodesis, all patients were very satisfied with their operation.

Adolescent↗

PubMed1993

[Protected early mobilization using Levame's device after primary repair of the extensor tendons of the hand. Apropos of a series of 88 cases].

Seventy patients with 88 lesions of the hand extensor apparatus were treated by primary repair followed by post-operative mobilisation with a dynamic steel blade splint (Levame). Results were good or very good in 97.7% of cases and moderate in 2.3% of cases for this series of simple lesions from zones 3 to 6. Prognostic factors influencing final result and wrist position during splint are discussed, the authors leave the wrist free for lesions in zone 3 and 4. Early mobilisation is the best treatment for tendinous lesions and a review of the literature confirms the validity of the author's choice. In spite of its biomechanical deficiencies, this simple technique may be used for non-disciplined patients and by non-specialized physiotherapists. For simple lesions of extensor tendons, the Levame splint may be considered as a real dynamic protective splint.

Adolescent↗

PubMed1993

[Congenital cutaneous aplasia. Apropos of 3 new cases located in the vertex].

Aplasia cutis congenita is a rare malformation characterized by absence of skin. We report three new cases, localized on the vertex with one appearing as a familial form and requiring an emergent surgical repair with a favorable outcome. After a review of the literature, the authors discuss nosological aspects and etiological problems which are still not resolved. It seems that vascular differentiation of the skin could play an associated role. As regards of treatment, different attitudes are possible and are exposed, with a preference for surgery which is the method of choice for the authors.

Abnormalities, Multiple↗

PubMed1991

[Urgent nature and severity of lesions due to high pressure injections in the hand].

High pressure injections in the hand and fingers are relatively rare accidents, but are responsible for serious lesions. Only extremely urgent treatment can minimise the aesthetic and functional sequelae. This treatment must include debridement of the portal of entry, exposure of all the contused and devitalised tissues and broad spectrum antibiotics. The postoperative course must include long and patient rehabilitation for these lesions which actually correspond to severe contusion of the hand and fingers associated with a high risk of septic dissemination. The authors describe these lesions based on a series of 20 consecutive cases.

Amputation, Surgical↗

PubMed1991

[Role of neurolysis of the posterior tibial nerve in plantar perforating diseases of diabetic origin].

Perforating ulcers of the foot in diabetics constitute a difficult therapeutic problem. In a series of 17 cases, the authors stress the value of tibial nerve neurolysis associated with periarterial sympathectomy which results in cure of the 15 patients treated within 30 days. Although no electromyographic improvement was observed, perfusion studies and oxymetry demonstrated an improved local vascular situation which promoted healing.

Adult↗

PubMed1989

Metacarpo-phalangeal thumb sprains based on experience with more than 1,000 cases.

The metacarpo-phalangeal thumb sprains are very frequent. They mostly occur during sports (50%), and the ulnar collateral ligament is the structure most frequently ruptured (86%). Surgical repair of all severe lesions and/or bony fragment avulsions has led to 90% of good, and excellent results, when the operation is followed by a proper physical therapy. Criteria for evaluation are considered and so is the management of the old or neglected sprains.

Adolescent↗

PubMed1989

[Joint lesions of the first column of thumb].

Lesions involving the thumb from the interphalangeal joint to the trapezo-metacarpal (TM) joint are very frequently the result of sports injuries. The authors discuss the most frequent lesions: 1) Dislocations of the metacarpo-phalangeal (MP) joint of the thumb which can be reduced in almost every case by means of well conducted orthopaedic manoeuvres. 2) Sprains of the MP joint of the thumb, very common lesions the severity of which must not be underestimated and which always require surgical treatment in the serious lesions, regardless of the compartment involved (radial or ulnar). 3) Bennett's fractures or fracture-dislocations of the TM joint; when neglected inadequately treated, these lesions lead to disabling post-traumatic arthritis of the TM joint. A poor result of treatment for any one of these three lesions always compromises opposition of the thumb and/or the strength of pollico-digital grip.

Fractures, Bone↗

PubMedDate not supplied

Postoperative management of extensor tendon repairs in zones V, VI, and VII.

This paper describes the postoperative management plan for extensor tendon repair in zones V, VI, and VII as conceived by the Grenoble team. This plan includes immediate, postoperative systematic mobilization for all patients with surgical repairs in zones II through VIII. Postoperative mobilization in zones V and VI is performed under the protection of a Levame-type, dorsal steel leaf-blade spring. Depending on lesion location, proximal or distal to juncturae tendinum, Frère's three-finger rule applies. In zone VII, differential tendon gliding between the wrist and finger extensors and surrounding tissue is accomplished with a Tom splint, which gives individual extension assistance to each digit and the wrist while limiting flexion.

Biomechanical Phenomena↗

PubMedDate not supplied

[Early exposure to open air of abdominal surgical wounds. Experiences in a general surgery department at a rural hospital in Burkina-Faso].

In one year time, in the surgery department of the Ouahigouya hospital (Burkina Faso, ex Upper Volta), from the 24th. hour after surgery, the authors exposed in the open air 96 out of 219 parietal abdomen sutures. Healing duration and suppuration rate, unfortunately high (24%) were not different whether the sutures were occluded with a dressing or not. According to the authors, clear economical interest, easy monitoring of the suture, absence of influence of precarious hygienic surrounding and of climatic conditions, and mainly satisfaction of patients, are convincing arguments to apply such a practice already largely utilized in some surgery departments in western countries.

Abdomen↗