Biomedical subjects
Publications and source records attributed to F Schuind.
Madura foot is the most frequent clinical form of mycetoma, which is a tumor-like destructive fistulized infection of the foot, caused by fungi. The only effective treatment is complete resection of the lesions. Leg amputation is frequently required.
The development of microvascular surgery has allowed the transfer of revascularized bone grafts. The surgical techniques of the most useful transfers are explained. The advantages, disadvantages and indications of these procedures, as compared with the other techniques of bone reconstruction, are discussed.
Twenty-four fractures or nonunions of the clavicle were treated by a Hoffmann external fixator, for selected indications. No vascular or pleural complications were observed. All clavicles healed, after a mean duration of 52 days.
Development of microsurgery has involved the use of revascularized bone grafts in maxillo-facial surgery. They are essentially indicated in rebuilding of complex tissues lost including bone. Their utility is well know in maxillofacial surgery, cervico-facial cancerology, ballistics trauma and in the cure of some mandibular osteoradionecrosis. Only scapular and iliac autogenous bone transplants were used by the authors. Following their short experience, they preferred the pediculated iliac transplants on the deep circumflex vessels more easy to handle and more secure. They brought some modifications in the graft technics in order to decrease the functional and the esthetic damages at the donor site: the incisions were parallel to the iliac crest an to the crural arch. The transplant respected the integrity of the antero-superior-iliac-spine and the crural arch. At the receiving site the muscle was left denuded in the oral cavity. The reepithelialization was observed in a short time.
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There is a rare and special type of macrodactyly that is called the hyperostotic variety. This disease occurs later than the classical forms of macrodactyly and shows massive osteocartilaginous deposits around the joints. A new case is reported. The cause of this disease could be previous trauma.
A new technique is presented for the treatment of comminuted intraarticular fractures of the base of the thumb metacarpal. A triangular Hoffmann external radius and first- and second-metacarpal fixator is used. The reduction is maintained by prolonged distraction and abduction of the first metacarpal bone. The application of the technique in three cases is reported.
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A technique of osteosynthesis of the clavicle with Hoffmann external fixation was used to treat twenty patients for selected indications, including an open fracture, inability of a patient to tolerate prolonged conservative treatment, or a painful non-union. No vascular or pleural complication was observed. The average time that the external fixator was retained was fifty-one days. All of the clavicles united well. Mobility of the shoulder returned to normal in all patients.
A patient is described in whom sarcoidosis caused a pathological fracture of the middle phalanx of the little finger. A bone scan showed increased uptake. She was treated by resection of the diseased area and bone grafting, which led to bone healing. The bony manifestations of sarcoidosis are reviewed.
Surgical treatment of skin ulcers from extravasation of chemotherapeutic agents produces a chronic ulcer. The origin of the disease and the techniques of wide local excision and of skin cover are discussed.
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The results of a prospective study of 588 patients operated on over a period of 4 months were analyzed. Of these patients, 6% only had to be hospitalized. The 555 other patients underwent out-patient surgery, 25% of which were emergencies. Thirty-four % of patients had one or more preexisting serious medical conditions. Ninety-one % underwent regional anesthesia. Complications were rare and did not seem to be preventable by hospitalization. While highlighting the many advantages associated with out-patient surgery, the authors stress the guidelines which must be followed as well as the pitfalls to be avoided in ambulatory surgery of the hand.
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Fractures of the hook of the hamate are rare injuries. Six new cases are presented; the most usual mechanism is probably a direct blow to the area of the hook. The diagnosis, which can only be made by special roentgenographic techniques is usually missed at the acute phase. Most of the cases are diagnosed when painful non-union, fraying tendinitis of the flexor tendons to the ulnar fingers, ulnar or median nerve deficits appear. The adequate treatment is usually excision of the hook fragment.
The homodigital island flap is a useful technique in problem cases such as distal amputation of the pulp, atrophic or insensative pulp on the index finger or thumb and painful neuromas. In a series of 60 operations preformed by one surgeon with the SOS Main in Strasbourg, we describe the indications for, and results of, several different techniques: unipedical flaps either advanced or "exchanged" and bipedical flaps either advanced or retreated.