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Biomedical subjects

G Foucher

Publications and source records attributed to G Foucher.

At least 73 records · Page 4Linked to original sources
PubMed1996

[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↗
PubMed1996

[Cover plasties of distal finger amputations. Focus on techniques and indications].

Distal finger amputations could be responsible for prolonged time off work and disability. Although delayed healing is the simplest method, a deep defect with exposed skeleton or tendon is an indication for a flap to provide cover with good padding and discrimination. Local flaps are the first choice and selection is based on a number of parameters, the most important of which is the real possibility of advancement. Although V-Y flaps are sufficient to cover a guillotine amputation, a very large defect requires more sophisticated techniques like such as two-pedicle or single-pedicled island flaps.

Amputation, Traumatic↗
PubMed1996

[Hueston's flap in distal digital amputations. Apropos of 43 cases].

John Hueston described an advancement rotation flap, sacrificing the innervation of the advanced skin. René Souquet proposed a modification of the technique to retain the sensitivity of the advanced skin. We reviewed 43 such flaps to compare the long term results with a median follow-up of 3 years. The mean 2PD was 6.8 mm for the classical technique and 5.9 mm for the modified flaps. The Semmes-Weinstein test was identical to the controlateral side in 77% and 92% of cases, respectively. These discrepencies were not statistically significant.

Amputation, Traumatic↗
PubMed1996

[Anterior tenoarthrolysis in flexion contracture of the fingers. Apropos of 41 cases].

PURPOSE OF THE STUDY: The "hook finger" with PIP and DIP flexion deformity, after multiple previous operations is difficult to treat. Classical PIP arthrolysis combined with tenolysis are frequently unsuccessful. We studied the result of an operation of Total Anterior Teno-Arthrolysis (TATA) as described by Saffar in 1978. MATERIALS AND METHODS: Among 41 patients with a mean age of 33 years, 73 per cent had at least one previous operation, on the flexor apparatus in the majority of cases. Global PIP and DIP lack of extension was 131 degrees with a mean PIP lack of 80 degrees. The operation consists in "en bloc" lifting of the finger volar aspect including the two neuro-vascular bundles, the flexor apparatus and the two volar plate, by dissecting underneath the periosteum of phalanges palmar aspect. The denuded distal squeleton is best covered by DIP arthrodesis combined with shortening. RESULTS: Only one complication occurred with PIP septic arthritis. With a mean follow up of 7.6 years, four fingers were not improved, none was worsened and 37 were improved. Mean post-operative PIP extension lag was 30 degrees, giving a global (PIP and DIP) gain of 86 degrees. The PIP AROM was only improved of 38 degrees. CONCLUSION: The benefit of this salvage operation is mainly a change of the AROM in a more functional arc. This has to be clearly explained to the patient and if accepted the satisfaction is high (90 per cent in our series).

Adolescent↗
PubMed1995

Plea to save the great toe in total thumb reconstruction.

Thumb reconstruction remains a controversial field. In young, well-motivated patients, in the absence of avulsion injuries, toe to hand transfer is an accepted procedure. With refinement, it is possible to avoid sacrifice of the great toe and in many cases avoid resorting to a second toe which is functionally and cosmetically insufficient. Custom-made reconstruction allows us both to save the donor great toe and to improve function and cosmesis of the donor site. Three basic techniques are reviewed: the modified wrap-around, bipolar lengthening, and twisted two-toes techniques.

Amputation, Traumatic↗
PubMed1995

A modified open palm technique for Dupuytren's disease. Short and long term results in 54 patients.

Fifty-four patients with Dupuytren's disease were operated on using transverse and Bruner incisions, leaving the transverse palmar and digital wounds open. The mean follow up was 6.6 years (minimum 5 years). The mean percentage correction of the overall fixed flexion deformity was 71%. The incidence of recurrence and extension of the disease were similar to other series of limited aponeurectomy. However, the postoperative complications were very much lower and the method is particularly suitable for patients over 50 years of age.

Dupuytren Contracture↗
PubMed1995

The anatomy of de Quervain's disease. A study of operative findings.

We have studied the anatomical findings at operation on 67 patients with De Quervain's disease, 5% of whom had bilateral lesions, compared with published series of cadaveric dissections. There was division with a septum in the extensor compartment in 60%. The abductor pollicis longus had more than one tendon in 76% and extensor pollicis brevis was represented by a single tendon in 96%. If there was an anatomical predisposition to the condition, more cases would have been bilateral. A septum and a crowded compartment are mainly responsible for the failure of steroid injections.

Adult↗
PubMed1995

A comparison of different surgical techniques in treating degenerative arthrosis of the carpometacarpal joint of the thumb. A retrospective study of 98 cases.

Between March 1977 and December 1991, 98 surgical procedures on 85 patients were performed at SOS Main Strasbourg for osteoarthrosis of the carpometacarpal joint of the thumb. The mean age was 56 and 90% were female; 13 were operated on bilaterally. 40% had Swanson arthroplasties (group 1), 15% Ashworth-Blatt hemiarthroplasties (group 2), and 45% had soft tissue arthroplasties (group 3). 62 cases were reviewed at an average follow-up of 5 years. Normal thumb range of motion was obtained in all cases, regardless of the technique used. Complete pain relief was achieved in 77% of the cases in group 1, 37.5% in group 2 and 71% in group 3. 15% of group 1 and 50% of group 2 required surgical revision, either for displacement or fracture of the implants. No revision was necessary in group 3. One case of silicone synovitis requiring secondary surgery was noted 6 years after surgery, accounting for 2.9% of the total number of silicone implants reviewed, but radiological signs of silicone synovitis were much more common (56%). Proximal metacarpal migration in group 3 averaged 38% of the initial arthroplasty space, and was not related to the type of ligamentoplasty used, or presence or absence of an "anchovy". The migration increased to 68% of the space if an associated MP joint arthrodesis was carried out at the same time. Complications included reflex sympathetic dystrophy (4% in group 1 and 14% in group 3). The Ashworth-Blatt hemiarthroplasty failed to gain satisfactory results, but both silicone arthroplasty and soft tissue arthroplasty proved to be useful procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Wrist denervation. Surgical considerations.

We have analyzed the results of 22 total wrist denervations following Wilhelm's technique and a series of 30 patients treated with denervation of the posterior interosseous nerve alone. Results of denervation have been classified depending on the pain (visual analogue scale) as other parameters (mobility and strength) have not been found to have any statistical significance. Results after partial denervation are worse than results achieved by total denervation.

Adult↗
PubMed1995

[Results of flexor tendon repair using the Tsuge technic. Apropos of a series of 95 fingers].

The authors review a series of 76 patients with 95 fingers involved, 66.6% of them occurring in zone II. The core stitch was performed according to the Tsuge technique (type II) combined with a peritendinous running suture. Results based on TAM were excellent or good in 60%, fair in 22%, and poor in 18%. Influencing factors were associated lesions, mainly vascular and lesions in zone II. Rupture occurred in 5% and adhesion in 22% of cases. Providing similar results to those of other techniques published in the current literature, the Tsuge techniques is preferred because it is simpler and faster to perform.

Adolescent↗
PubMed1995

[Modification of the Furnas-Vilkki technic in the reconstruction of congenital or traumatic carpal hands].

A technique is described for reconstruction of a pincer, by a second toe transfer, in traumatic and congenital deformities, leaving only the wrist. Transfer on the anterior aspect of the radius allows to benefit from the wrist mobility to compensate for the limited range of motion of the second toe. Proximal situation of the toe gives the possibility of harvesting plenty of tendons to balance the toe. Results have been encouraging in two traumatic and 6 congenital cases of peromelic type of symbrachydactyly.

Adolescent↗
PubMed1995

[A psychological approach to patients undergoing ambulatory surgery].

200 patients undergoing outpatient hand surgery were included in a sociological and psychological study. Certain points were found to be important: structure adapted to outpatient surgery, a single team, availability of the surgeon 24 hours a day, telephone call on the day after the operation, etc. Only 0.5% of operated patients claimed to be unhappy with their outpatient experience, but 2.5% would have preferred admission to hospital (for comfort reasons). Overall, outpatient procedures make the patient and his family responsible, by stimulating his cooperation and avoiding regression and dependence, frequently encountered in conventional hospitalization. Psychoanalysis has an important place in the pre- and postoperative approach to the patient.

Adolescent↗
PubMed1995

Association of Wartenberg's syndrome and De Quervain's disease: a series of 26 cases.

We report on a series of 25 patients (26 cases) presenting an association of Wartenberg's radial neuritis and De Quervain's tenosynovitis. In all patients the diagnosis was made on clinical grounds. In group 1, conservative treatment of Wartenberg's syndrome was used in 16 patients (associated with surgical release of the first extensor compartment in 5 patients). Of the 14 patients available for follow-up at an average of 15 months, 9 (64 percent) were excellent and good results. In group 2 (11 patients, with 1 failure of conservative treatment), surgical treatment addressed both conditions. Neurolysis has to be performed at the classic proximal site of entrapment (constant excellent and good results), for the 2 cases of neurolysis at the styloid level gave fair results. It is particularly important to identify an associated Wartenberg's syndrome before performing a release of the first dorsal compartment to avoid incomplete relief or even aggravation of neuritis, exposing the surgeon to litigation.

Adult↗
PubMed1995

[Compression of the ulnar nerve at the elbow. Results of a series of 51 medial epicondyle osteotomies associated with decompression].

PURPOSE OF THE STUDY: Despite many publications concerning the physiopathology and the treatment of Ulnar tunnel syndrome treatment remains controversial. MATERIAL AND METHODS: The authors reviewed 51 patients operated on for ulnar nerve entrapment at the elbow by neurolysis combined with medial epicondylectomy in case of luxation or subluxation of the nerve. Average was 39 years, 74 per cent being males, 53 per cent manual workers. According to Mc Gowan's classification, 39 per cent were grade I, 12 per cent grade IIA, 20 per cent grade IIB and 29 per cent grade III. RESULTS: Few postoperative complications occurred: one postoperative hematoma, 4 painful scars without neurinoma, and one case of an elbow extension lag of 15 degrees. With an average follow-up of 4.6 years, 39 per cent of the patients were cured, 27 per cent improved, 31 per cent unchanged and none worsened. As in all others techniques, excellent results only occurred in grade I and IIA. DISCUSSION: Anatomical and physiopathological studies show that compression, friction and elongation are the 3 components of the ulnar tunnel syndrome. The different conservative and surgical treatments are analyzed, taking into account both advantages and drawbacks. The medial epicondylectomy with decompression allows a "mini transposition" of the nerve but keeps the vascularization and the nerve intact. Its simplicity and our results are confirmed by all other series analyzed in the literature.

Adolescent↗
PubMed1995

Second toe-to-finger transfer in hand mutilations.

A series of 68 second toe-to-long finger transfers in 55 patients, including 52 transfers in 41 patients with mutilating injuries and 16 transfers in 14 patients with congenital deformities, was reviewed. Mean followup was 6.7 years. The failure rate was 6%, and secondary procedures were done in 18% of the patients. In the group with traumatic injuries, mean flexion was 36 degrees, with a mean extension lag of 33 degrees. Two-point discrimination was an average of 11 mm. Grasp was 47% of that for the normal contralateral side, and pinch was 38%. Of the manual workers, 62.5% returned to the same job. Analysis of the congenital series was more difficult. Although mobility was not significantly better in these patients, discrimination was a mean 5 mm (10 patients were tested). Growth plates remained open in 86% of the patients. All patients were able to use their finger to pinch.

Adolescent↗