Prospects for hand transplantation.
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Adaptation, Psychological↗
Biomedical subjects
G Foucher
Publications and source records attributed to G Foucher.
Long-term outcome of neurovascular palmar advancement flaps for distal thumb injuries.
Thirteen neurovascular palmar flaps for thumb tip coverage were reviewed: six O'Brien and seven Moberg flaps with a mean follow-up of 81 months. Both techniques were found to be safe and effective in preserving pulp sensibility, with a mean 2PD of 5 mm and a Semmes-Weinstein identical to the contralateral side in nine cases. The interphalangeal joint regained a normal range of motion, and did not seem to be affected by the perioperative flexion. The main residual complaints were persistent cold intolerance (present in all cases and severe in three), pulp instability (present in six and severe in two), and nail deformity. This last problem was more related to the injury. Despite these drawbacks, O'Brien and Moberg flaps remain the first choice for coverage of 1-2 cm pulp defects of the thumb.
Adolescent↗
Microvascular great toenail transfer after conventional thumb reconstruction.
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Adolescent↗
[Joint denervation, a simple response to complex problems in hand surgery].
STUDY AIM: In patients with preserved mobility and stability a painful joint remains a difficult problem, especially in elderly patients. All operations, including intracarpal arthrodesis, reduce an already limited mobility, require prolonged immobilization and have a high rate of complications. Denervation could be proposed in such cases. MATERIALS AND METHODS: In our study denervation was performed on 132 wrists, 36 first carpo-metacarpal joints and 32 proximal inter-phalangeal joints. RESULTS: We have been disappointed in the past by partial wrist denervations. Fifty cases of complete and isolated wrist denervation were reviewed with a mean 5-year followup. Strength and mobility were only marginally improved but pain was decreased by a mean 75% (on a visual analog scale) in 74% of patients. At the proximal inter-phalangeal joint level, the mean pain improvement was 88% in 85% of patients. At the first carpo-metacarpal joint level, results of denervation were less predictable and the mean pain improvement was 67% in 81% of patients, with a mean 17-month follow-up. CONCLUSION: Joint denervation is a simple but precise operation performed under local anesthesia and on an outpatient basis. It provides good results in elderly patients, with few complications.
Adult↗
Conservative versus operative treatment for Kienböck's disease. A retrospective study.
In this retrospective study on Kienböck's disease, a comparison was made between 21 cases operated on by various techniques and 22 cases treated conservatively, with a mean follow-up of 65 months. Operative management of the disease did not show any superiority over conservative treatment. Moreover, surgery was responsible for a loss of mobility of 24%, and for a change in social activities in about a quarter of the patients, while grip strength was only slightly improved. Surgical indications for Kienböck's disease should be carefully considered, keeping in mind their side-effects, and the relative benignity in some cases of the natural course of the disease.
Adult↗
The bipolar lengthening technique: a modified partial toe transfer for thumb reconstruction.
The authors describe a new technique for reconstruction of the thumb after amputation through the proximal phalanx. Bipolar lengthening is a combination of first web deepening by an Ostrowski flap and a distal lengthening by a free vascularized compound transfer of pulp, nail, and bone harvested longitudinally from the distal phalanx of the great toe. Seven cases have been reviewed by an independent observer after a mean follow-up of 46 months. There were no technical failures. The mean static 2-point discrimination was 6.3 mm, and the Semmes-Weinstein monofilament testing was identical to that of the contralateral side in four patients and increased in the other three. After correction for hand dominance, grip strength was 89 percent of that of the contralateral side, and pinch strength was 81 percent of that of the contralateral side. First web span was symmetric in four patients and diminished in the other three. The bipolar technique creates a short thumb, which avoids exposing the thumb to trauma when making a fist, without limiting first web span.
Adolescent↗
[Skin problems in severe retraction stiffness of the hand and fingers. Role of the so called "castle" flap].
Skin retraction is a commonly observed complication of severe joint stiffness in the hand. After freeing the joint, this raises the problem of closing the skin without tension to avoid necrosis, disunion or pain during early rehabilitation and splinting. We have used a simple rotation flap for PIP extension (and hyperextension) stiffness and a "castle" flap for PIP flexion retraction and for both extension and flexion stiffness of the MPJ. It consists in withdrawing the skin (dorsal or palmar) of the phalanx distal to the freed joint. We have used this flap in 13 clinical cases of severe stiffness and it allowed wide access to all structures involved and facilitated early post-operative mobilization.
Contracture↗
[What's new in the treatment of Dupuytren's disease?].
Among the recent advances in the field of Dupuytren's contracture, the authors reviewed a series of 171 patients treated by percutaneous needle fasciotomy. Among the 198 hands (241 fingers), 65 were reviewed with a mean follow-up of 2.5 years. Mean age was 62 years and delay between onset and treatment 6.8 years. Rupture of the cords was performed only in the palm in 154 cases, palmo-digital in 82 and purely digital in 5 cases. Complications were rare and benign without tendon or vascular bundle injury. Postoperative gain was essentially observed on the metacarpo-phalangeal joint and recurrence rate was high despite the short follow-up (progression of the disease 54% of cases). The ideal indication for this simple and reliable technique is an elderly patient with a prominent cord and predominant lack of metacarpophalangeal extension.
Adult↗
[What's new concerning carpal tunnel syndrome?].
Despite its frequency, carpal tunnel syndrome is still a subject of debate in the literature. Is a clinical diagnosis sufficient to justify the indication for surgery? Electromyography appears to play a very important role and, apart from its diagnostic and medicolegal value, may reveal associated lesions able to account for persistence of certain symptoms in the medium- or long-term; about which the patients must be informed. More general social questions are raised by the recognition of occupational carpal tunnel syndrome and its economic implications. Medical treatment by nocturnal resting splint still has a real place and endoscopy constitutes an alternative to classical open surgery. Surgical techniques must comply with rigorous rules, the only way of ensuring security and prevention of recurrences, which are difficult to treat.
Adrenal Cortex Hormones↗
[Medical English at the medical school. The Dijon experience].
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Curriculum↗
Ax injuries of the hand.
OBJECTIVE: To review a series of ax injuries of the hand. DESIGN: Retrospective epidemiological review of 125 cases. MATERIALS: Assessment from the notes of all injuries, with more detailed follow-up of 26 cases. MEASUREMENTS: Levels of injury, surgery required, complications, results, patient satisfaction, methods of prevention. CONCLUSIONS: Ax injuries are rare. They usually affect the thumb and index finger of the nondominant hand. As with all hand injuries, expertise in dealing with bone, tendon, nerve, and skin cover is essential. Even "minor" injuries may give rise to considerable morbidity. Our complication rate in replantation was 50%. Care should be taken here not to compromise the result by attempting to maintain the length of the bony skeleton. The long-term results (at 11 months to 12 years) were generally satisfactory, but cold intolerance may persist for many years. As with all accidents, prevention would be better than cure. Neither we nor the patients could think of any way of significantly reducing the incidence of these accidents. However, holding the ax by the neck seemed a common way of sustaining injury.
Adolescent↗
Digital reconstruction with island flaps.
Better understanding of the vascular anatomy of the hand and of flap perfusion allows the hand surgeon to perform single-stage reconstruction of digital defects through a multitude of island flap transfers. The usefulness of more than 20 separate island flaps is discussed, and the technique of flap transfer is presented for each.
Finger Injuries↗
Regional intravenous sympathetic nerve blocks.
The assessment of the possible efficacy of regional intravenous blocks or sympathetic blocks, in general, raises a number of questions that may be answered after studying the techniques of regional pharmacologic segmental blocks and their effects on the sympathetic system. The authors present an original clinical study evaluating the capacity of regional intravenous guanethidine to induce a sympathetic blockade compared with other techniques.
Adult↗
Finger joint reconstruction after mutilation of the hand.
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Arthroplasty↗
[Toe transplantation in congenital malformations of the hand].
Toe transfer is a well established procedure for thumb and finger reconstruction after mutilation. The indications in congenital malformations are a mater of controversy. Out of a personal series of 209 patients, 42 were children presenting a congenital malformation. Thirty six, with 46 transfers were available for review. There is only one failure at the beginning of our experience. The main indication was absence of pinch either due to absence of thumb (like in congenital band syndrome or some extreme cases of ulnar club hand or cleft hand) or absence of long finger (like in symbrachydactyly monodactylous type) or lack of both thumb and finger (like in peromelic type of symbrachydactyly). In this last type, we have been disappointed by the functional result of the distal implantation of two second toes taken from both feet; we have proposed a "stub" operation consisting in a second toe transfer on the anterior aspect of the radial epiphysis to take advantage of the mobility of the wrist and the availability of plenty tendon transfer (in this proximal situation). When planing to "built" an absent pincer, an early age is mandatory for operation (mean 12 months), to ensure a good cortical integration. A less frequent indication is a partial toe transfer with a vascularized epiphysis to provide growth and mobility in some cases of thumb hypoplasia (like in symbrachydactyly or Blauth and Manske type III b). Results are difficult to assess due to the early operation but if the mobility has been disappointing (mean 32 degrees), sensibility (mean 2PD 5 mm) and growth were excellent.
Child, Preschool↗
Long-term results of splintage for mallet finger.
Splinting of acute mallet finger injury is widely practiced. Few long term studies of the results have been published. We reviewed 156 mallet finger injuries after such treatment at 6 months and 61 months after injury. At six months the mean extension lag was 7 degrees and the mean range of active flexion was 61 degrees. After 61 months the extension lag was 5 degrees and active flexion was unchanged. In light of the above we do not consider routine long term follow of mallet finger injury to be necessary after treatment with splintage.
Adult↗
Transfer of a severely damaged digit to reconstruct an amputated thumb.
We retrospectively reviewed the results of reconstruction of a traumatically amputated thumb with use of an adjacent severely damaged digit in twenty-seven patients (twenty-five male and two female patients). The mean duration of follow-up was nine years (range, two to twenty-one years). The mean age at the time of the reconstruction was thirty-four years (range, thirteen to fifty-six years). Five patients had the reconstruction on the day of the injury and twenty-two, after a mean delay of five months (range, fifteen days to thirteen months). Segments of the index finger were used in twenty-two patients; of the long finger, in four patients; and of the ring finger, in one patient. There were four complications: necrosis of the dorsal skin in one patient, reflex sympathetic dystrophy in one patient, and contracture of the first web space in two patients. Discriminative sensibility was ten millimeters or less, according to the Weber test, in twenty-four thumbs. Cortical integration with reference to the recipient thumb, on stimulation of the pollicized segment, was good in ten patients. Eleven patients could achieve tip-to-tip contact between the thumb and the little finger and twenty-five patients, between the thumb and the most radial finger. The ability to perform activities of daily living was considered good for ten patients, fair for eleven, and poor for six. Only digits with a nail, either present on the transferred segment or as a result of a free vascularized nail transfer, were considered to have a good cosmetic result. Although these results are far from impressive, the reconstruction is a viable alternative for selected patients because it maintains the ability to grasp objects and to oppose the digits.
Activities of Daily Living↗
[Reconstruction surgery after traumatic amputation of the thumb].
Reconstruction of the thumb after traumatic mutilation constitutes a delicate indication in order to select the technique most adapted to the patient's functional needs and esthetic desires. Pollicizations of healthy fingers are now used less frequently, except in the clinical context of very proximal amputations, but amputations of mutilated fingers remain a frequent indication. Progressive lengthening was associated with a high complication rate, although these complications have remained minimal. Osteoplastic reconstruction is still occasionally indicated in its modern version of composite flap. Finally, toe transfers now have a large place in young subjects, "tailored" transfer is preferred to first or second toe transfer in the case of isolated amputation of the thumb, due to its esthetic advantages.
Amputation, Traumatic↗