Biomedical subjects
Publications and source records attributed to G Foucher.
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Vascularized free nerve grafts make possible the repair of extensive defects of large nerve trunks. Since the original observations of Taylor and Ham in 1976 many cases have been published. The ulnar nerve in the upper arm in most cases has a simple arteriovenous pedicle the anatomy of which has been precisely defined by cadaver dissections and intravascular injections. The arterial supply, 47 times out of 50, is the proximal ulnar collateral and 2 times the distal collateral ulnar artery. It takes its origin from the medial side of the brachial artery in the upper or middle third of the arm. Its external diameter is on the average 1.8 mm at its origin. The accompanying vein enters a brachial vein 2 to 3 cm below the origin of the artery. The removal of the graft is done through a straight incision on the inner aspect of the arm. The brachial artery is dissected from above downward and its medial branches noted. The nerve and its arteriovenous pedicle are separated in a block along with adjacent cellular tissue by dissection from below upwards. The average length of the pedicle thus produced is 13 cm, but a much longer section of the nerve can certainly be taken. A case report illustrates the procedure.
The authors describe the specific features of hemangiomas of the hand in adults (three cases). The clinical syndrome is described. The main examination is by arteriography of the hand which shows three principal aspects: the vascular topography; the volume of the tumors; the extension of the neighbouring tissue. The treatment is analysed: surgical exeresis; in some cases, microvascular transplants are necessary (especially for the distal reconstruction of a finger); embolization is normally avoided because of the risk of necrosis of the finger.
The trapezo-metacarpal joint has a complex structure with specific anatomical, physiological, radiological and clinical characteristics. Several anatomical descriptions of this joint are available, and we believe one should know it well in order to understand its radiological problems. For instance a wrong projection may lead to overlook a fracture, especially in the trapezium. Several mechanisms have been suggested to explain the lesions of the base of the first metacarpal and of the trapezium. The therapeutic consequences of these considerations are not very important. Regardless of the lesion, two methods seem to yield the best results: Iselin's double pinning; oblique traction as suggested by L. Thoren. A perfect reduction is most important in both methods, as is usually the case fort any articular structure. This will reduce the risk of trapezo-metacarpal arthritis which still remains an unpredictable complication.
The reversed deepithelialized flap was used by Clodius for the lower limb and Pakian was the first to report on the use of this procedure in the hand. In the operation a classical cross-finger is deepithelialized and turned over on to an adjacent finger. The dermal part comes in contact with the exposed structures of the defect to be covered. This technique increases the indications for the cross-finger flap to many cases, where the classical flap is not possible.
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The authors have made an analysis of the results obtained after surgical correction of 30 malunited metacarpals and phalanges. Nine involved joints, but the remainder did not. In 25 cases, there was limited movement associated with the malunion. The surgical devices were specially designed for surgical treatment and the technique employed is described. It is concluded that the correction of malunion needs to be made but that this alone is not sufficient to obtain a satisfactory result. The effectiveness of added tenolysis, arthrolysis, post-operative bracing and rehabilitation is even more important. The indications for treatment are given according to the level and location of the malunion.
The authors propose an anterior approach to perform the amputation of the index finger according to Chase. The palmar access brings more facility to cut the tendons and nerves. The scar on the palmar side of the hand is quite invisible.
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Transplantation of the second toe to replace a finger has been suggested more recently than has transplantation of the great toe to replace the thumb. The technique is described in detail. There is no plantar skin incision in the foot. The arterial suture is made at the level of the digital artery. Two toes can be transplanted when several fingers are missing. 11 cases have been operated on and the results analysed. In all cases, pinch grip between the thumb and the transplanted finger was made possible.
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