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Biomedical subjects

G Foucher

Publications and source records attributed to G Foucher.

At least 91 records · Page 5Linked to original sources
PubMed1995

[A comparative study of metacarpal resection and translocation after amputation of the middle finger].

The authors studied 43 patients having sustained an amputation of one middle finger treated either by simple ray resection or translocation. The index-middle translocation was followed by more minor postoperative complications compared to all other techniques. A global score, taking into account daily activities, cosmetic result lack of mobility, residual pain, decreased strength, time off work, and return to work gave 131 points for simple third ray resection compare to index middle translocation (-252 points). Surprisingly, reduction of hand span on X ray study was minimal but strength was not correlated and translocation gave better strength, and therefore appears to be more appropriate for manual workers. For ring amputation, the score was definitely better for Leviet translocation with intracarpal osteotomy (143 points versus -36 for simple ray resection). However, the only drawback is more frequent (but minor) residual pain.

Activities of Daily Living↗
PubMed1995

[Validity of clinical signs and provocative tests in carpal tunnel syndrome].

The relevance of EMG study was assessed to ascertain the diagnosis of carpal tunnel syndrome in cases of positivity of clinical signs and provocative tests. A prospective study was conducted in 60 patients presenting 85 symptomatic hands. Correlation between 11 signs and tests (isolated or associated) was performed with EMG used as "standard". None of the signs or tests reached an acceptable level of sensitivity, specificity or predictive value. This exam was positive in only 62 per cent of cases. EMG seems to mandatory before deciding on surgical release of the carpal tunnel syndrome.

Adult↗
PubMed1995

[Results of orthopedic and surgical treatment of mallet finger by subcutaneous rupture of the extensor tendon. Apropos of a series of 216 cases].

PURPOSE OF THE STUDY: To assess the late results of orthopaedic and surgical treatment for mallet finger, two groups of patients were reviewed in a retrospective study. MATERIAL AND METHODS: 156 fingers (Group I) had conservative treatment and 60 fingers (Group II) some form of surgical treatment. RESULTS: In Group I, a dorsal custom-made perforated splint maintained the distal interphalangeal joint (DIP) in extension for an average of 54 days (st13). The mean delay of presentation was 22 days (st36). Initial lack of extension was 35 degrees (st13). After an average follow-up of 154 days (st240), the lack of extension was only 7 degrees with an active range of flexion of 61 degrees (st11). 68 of these patients were reviewed for a long-term assessment (61 months). At this time, lack of extension and range of flexion were not different (respectively 5 degrees- st10 and 61 degrees- st16). In Group II, 45 per cent of patients had initially some form of orthopaedic treatment. Delay between injury and consultation was 118 days (st250). Review with a mean follow-up of 5.6 years demonstrated a lack of extension and a DIP joint flexion of 12 degrees and 53 degrees for tenodermodesis (14 cases), 2 degrees and 59 degrees for the Thompson and Littler procedures (14 cases), 1 degree and 55 degrees for the Fowler tenotomy (10 cases). DISCUSSION AND CONCLUSION: Orthopaedic treatment gave good functional results even in cases with delay of presentation. Surgery is only indicated in failure of conservative treatment. In absence of swan-neck deformity, tenodermodesis is a simple and effective technique. When a swan-neck is present, if the DIP deformity is corrected by PIP stabilization, the Fowler tenotomy is used. Otherwise, the Thompson and Littler operation allows to fully correct the deformity.

Adult↗
PubMed1995

The "stub" operation--modification of the Furnas and Vilkki technique in traumatic and congenital carpal hand reconstruction.

A technique is described for reconstruction of a pincer, by a second toe transfer, in traumatic and congenital deformities, leaving only the wrist. An anterior transfer on the radius allows the wrist mobility to compensate for the limited range of mobility of the second toe. Proximal situation of the toe gives the possibility of having plenty of tendons to balance the transfer. From 1987 to 1992, 8 such operations were performed, 2 in traumatic amputations and 6 in cases of congenital anomalies. The mean age of the congenital patients was 13 months (range, 11 to 21 months) and the 2 traumatic patients were 17 and 20 years of age. In one of the traumatic cases, a sensibility of 11 mm was obtained at 22 months and the wrist mobility in flexion was 55 degrees. The overall mobility of the toe was 35 degrees. In the second traumatic case, the two-point discrimination was 11 mm on the second toe and 10 mm on the great toe pulp. The wrist mobility remains limited (around 20 degrees) but distant contact is possible. In most of the congenital patients the mean mobility reached an average of 40 degrees at the toe level whereas the wrist mobility was an average of 52 degrees, an improvement over peroperative values. In all the 8 patients, the epiphyses remain open.

Adolescent↗
PubMed1995

Thumb reconstruction by micro-vascular techniques.

Sixty-three patients with thumb reconstruction by total or partial toe transfer have been reviewed. Mean age was 25 years. Males (84%) and manual workers (76%) dominated the series. The rate of failure was 3%. Second toe transfer gave a functionally acceptable thumb with 10 mm two point discrimination, 59% of strength in pinching (compared to normal side), 30 degrees of range of flexion but with a flessum deformity (average 27 degrees) and a poor cosmesis score (1.5 on a 5 point scale). Partial toe transfers were useful in amputations at metacarpophalangeal (MP) level and distal to this area. Around MP level, three techniques were available: wrap around, Twisted Two Toes and "bipolar" lengthening. More distally a "custom made" transfer allows to match exactly the defect. All of these techniques save the great toe length. When a pulp was incorporated in the transfer, two point discrimination averaged 9 mm and in the entire series the mean pinch strength was 93% normal and the mean cosmetic score was 3.5 points. Partial toe transfers are preferable in cases with any otherwise normal hand, providing good function and better cosmesis.

Adult↗
PubMed1994

[Complex injuries of the hand].

For many years, the rule "Emergency Treatment, Deferred Surgery", advocated by Marc Iselin, led to saving severely injured hands by postponing surgery and leaving it to highly specialised surgeons. With the appearance of microsurgery, which can be used for arterial and venous repair, the notion of actual emergency has returned and has led to the philosophy of "One-Stage Repair with Early Mobilisation". This consists in emergency repair of all the lesions and selection of techniques compatible with active mobilisation in the first postsurgical days. It is thus possible to avoid the major complication represented by stiffness of the hand in the fundamental role of grasping which requires mobility and sensitivity. Thus, Units for Emergency Hand Treatment must be created. In 1972 Raymond Vilain had the foresight to open the first such unit, "SOS MAIN". In 1975 a unit was opened in Strasbourg and five years later the European Federation of Units for Emergency Hand Treatment was born; today it comprises approximately 40 units within Europe.

Bone Nails↗
PubMed1994

Correlation of clinical signs with nerve conduction tests in the diagnosis of carpal tunnel syndrome.

In order to establish the need for nerve conduction studies, a prospective study has been performed on 112 patients with symptoms of carpal tunnel syndrome (172 symptomatic hands), seeking correlation with 11 clinical criteria taken either singly or in combination. Even when the patient presents with a typical clinical presentation of carpal tunnel syndrome the diagnosis is only confirmed electrophysiologically in 61% of cases. Analysis of the sensitivity and specificity of various clinical tests and diagnostic manoeuvres has shown their mediocre reliability in establishing the diagnosis with a sensitivity of 58% and a specificity of 54% for Phalen's test.

Adult↗
PubMed1994

The Hueston flap in reconstruction of fingertip skin loss: results in a series of 41 patients.

We reviewed 43 Hueston flaps in 41 patients (average age, 35 years) following distal fingertip skin loss. Mean advancement of the flap was 13 mm. Patients with single-digit injuries missed an average of 36 days off work. At the follow-up evaluation (mean, 3 years), 10 patients complained of pain (1 with functional impairment), 30 complained of cold intolerance, and 24 had nail deformities. Sensibility of advanced skin was normal by Semmes-Weinstein test in 33 cases, while two-point discrimination averaged 7 mm. This discrimination was virtually identical to contralateral digits in 31 of the cases. Overall, 30 patients were satisfied with their results, while 11 patients were mildly displeased. In 10 patients, this involved impairment of function, while the remaining patient was displeased with the appearance.

Adolescent↗
PubMed1994

Free and island vascularized joint transfer for proximal interphalangeal reconstruction: a series of 27 cases.

Twenty-seven vascularized joints were transferred in 26 patients for proximal interphalangeal joint reconstruction: 7 heterodigital island, 7 homodigital island (distal to proximal interphalangeal), 2 free heterodigital, and 11 free second toe proximal interphalangeal. With a mean follow-up period of 37 months, mean active range of motion of heterodigital island joint was 56 degrees (mean extensor lag, 21 degrees), excepting one failure ending with an arthrodesis. Four complications occurred in the homodigital island joint series: one sepsis, one nail dystrophy, one failed distal arthrodesis, and one bone abutment in flexion. Excluding the sepsis, mean active final range of motion was 52 degrees after a mean follow-up period of 18 months. The two free heterodigital joints had 80 degrees and 65 degrees of motion. The worst results occurred in the free second toe proximal interphalangeal joints transferred, with a mean active range of motion of 33 degrees (mean extension lag 39 degrees). The main advantages of these techniques are a compound tissue transfer, rapid bone healing, good lateral stability, growth potential, and long-term cartilage preservation.

Adult↗
PubMed1994

Detection of glomus tumor of the finger by dedicated MRI at 0.1 T.

Three glomus tumors of the fingers were detected using a dedicated hand and wrist low field (0.1 T) MR imager equipped with solenoidal coils allowing a FOV of 2 cm. Three-dimensional T1-, T*2-, or T2-weighted images were used (8 contiguous slices of 2 mm thickness). Glomus tumors had low or intermediate signal intensity (2 cases) or no signal (1 case) on T1-weighted images. On T*2- or T2-weighted images they had high signal intensity. MRI findings correlate well with surgery and biopsy.

Adult↗
PubMed1994

[Camptodactyly: classification and therapeutic results. Apropos of a series of 50 cases].

Fifty patients with camptodactyly of one or several fingers were seen in the Strasbourg SOS Main unit between 1980 and 1988. Classification of these lesions was based on the mobile or fixed nature of the deformity in flexion of the interphalangeal joint. This classification is useful for the therapeutic management. Treatment by dynamic splint for a mean duration of 20 months gives good results in fixed or mobile camptodactylies of small children, provided that this treatment is commenced as soon possible. This splint treatment also obtains favorable results in patients reaching the end of the growth period, whether their camptodactyly is mobile or even, in some cases, fixed. In every case, treatment by dynamic splint constitutes a therapeutic test (safety of the apparatus, patient's cooperation) and only forms of camptodactyly resistant to conservative treatments benefit from Malek's type of surgical correction. It must be remembered that a certain number of cases of camptodactyly have a potential for severity with time, progressing towards irreducible forms which can only be corrected by surgical treatment. Camptodactyly in adults must be analysed meticulously and only major deformities causing functional discomfort or major aesthetic prejudice should be operated.

Adult↗
PubMed1994

[Anterior interosseous flap].

An anatomical study which was carried out on 44 upper limbs of fresh cadavers has enabled us to describe a new flap based on the superior perforating branch of the anterior interosseous artery: "the anterior interosseous flap". The anterior interosseous artery participates in the vascularization of the dorsal aspect of the distal two-third of the forearm by providing two perforating branches, "the superior and the inferior perforating branches". The superior perforating branch of the anterior interosseous artery, pedicle of the flap, perforates the interosseous membrane 10 +/- 2 cm above the radio-carpal joint and runs in the septum between the extensor pollicis longus and brevis muscles accompanied by two venae comitantes. The calibre of the artery at its origin varies from 0.9 to 1.5 mm. During its course, the artery gives 5 to 7 septocutaneous branches to reach the overlying skin in the posterior aspect of the distal two-thirds of the forearm. It also gives 3 to 5 osseous branches spreading over the dorsal aspect of the distal third of the radius and several muscle branches to the abductor pollicis longus, extensor pollicis longus and brevis, extensor indicis and extensor digitorum muscles. The inferior perforating branch of the anterior interosseous artery generally perforates the interosseous membrane 4 to 5 cm above the radio-carpal joint. After giving a medial branch which anastomoses with the posterior interosseous artery (in 42 out of 44 cases) the inferior perforating branch of the anterior interosseous artery always runs distally to join the dorsal vascular network of the wrist which is rich enough to produce a retrograde arterial blood flow. This flap can be used as an island flap (with a retrograde or a direct blood flow) or a free flap. The surgical procedure of the retrograde island flap consists in raising the cutaneous or compound flap based on the superior perforating branch, division of the interosseous membrane and ligature of the anterior interosseous trunk proximally. The flap is vascularized by a retrograde blood flow through the dorsal (or volar or both) vascular network of the wrist. Theoretically, the most distal point of rotation of the flap is located at the level of the luno-capitate joint and the pedicle is long enough to allow the most distal point of the flap to reach the DIP joint of the finger.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

Entrapment of the superficial branch of the radial nerve (Wartenberg's syndrome). A report of 52 cases.

We have treated 50 patients (52 cases) of entrapment of the sensory branch of the radial nerve in the forearm (Wartenberg syndrome) between January 1988 and July 1992. Conservative treatment achieved 71% excellent and good results. Operation was followed by 74% excellent and good results. The indications for each type of treatment are discussed. De Quervain's disease was associated in 50% of cases, and it is important to diagnose Wartenberg's syndrome before operating on the tenosynovitis in order to avoid unexpected postoperative complications and medicolegal problems.

Adult↗
PubMed1993

Observations on experimental flow-through venous flaps.

The aim of this work was to compare the survival of an arteriovenous island flap with the survival of an island flap with a flow-through venous supply. Our experimental studies were performed on 95 Wistar rats randomised into six groups: Group 1: Indian ink injection of flow-through venous flaps with capillary network; Group 2: control group deprived of vascularisation; Group 3: control group with arteriovenous supply; Group 4: flow-through venous flaps of group 1; Group 5: epigastric flow-through venous flaps with a main venous trunk; Group 6: histological examination of flow-through venous flaps. The survival of flaps was monitored by direct examination, histological examination, capillaroscopy, and laser Doppler. Three out of 50 flow-through venous flaps survived. There was a statistically significant difference in the delay of clinical necrosis between the composite non vascularised free grafts (2.8 +/- 1.2 days) and the flow-through venous flaps (4.1 +/- 1.3 to 4.9 +/- 1.1 days depending on the type of flap). A 20% decreased venous blood flow was observed in the flow-through venous flaps.

Adipose Tissue↗
PubMed1993

A post-operative regime after digital flexor tenolysis. A series of 72 patients.

Tenolysis of the flexor tendons was performed in 78 fingers (72 patients) by the same surgeon. Two technical modifications were introduced: reconstruction of a robust pulley; and initial immobilization with the tendon in a proximally migrated position, permitting later breakdown of early adhesions by gentle extension either by the surgeon or using an extension spring. After a mean follow-up of 21.5 months, the total active movement was improved from 135 degrees (pre-operative) to 203 degrees (post-operative) in 84% of fingers and from 65 degrees to 115 degrees in 78% of thumbs. This corresponds to a reduction in impairment of 10.1% for the thumb and 21.6% for the fingers. There was no improvement in four digits and nine cases were made worse, averaging a loss of range of 25.4 degrees. Among these were two cases of skin breakdown and two cases of tendon rupture (2.5%), one combined with skin necrosis.

Adult↗
PubMed1993

[Influence of the anatomy of the pedicle on the survival of venous vascularized flaps. Experimental study on the rat].

The aim of this work was to compare the survival of an arteriovenous island flap with the survival of an island flap with a venous supply. The anatomy of the pedicule was modified to assess the conditions of survival. Our experimental studies were performed on 125 Wistar rats randomised into eight groups. Group 1: control group of epigastric flaps deprived of vascularisation. Group 2: control group of abdominal transverse flaps with arteriovenous supply. Group 3: control group of epigastric flaps with arteriovenous supply. Groupe 4: through-flow abdominal transverse venous flaps. Group 5: epigastric through-flow venous flaps with a main venous trunck. Group 6: epigastric flaps with nervous and perivenous pedicule. Group 7: epigastric flaps with nervous and venous pedicule. Group 8: epigastric flaps with through-flow nervous and venous pedicule. Twenty-four additional rats were histologically assessed. The survival of flaps was monitored by direct examination and histological examination. Two out of the 20 flaps of group 4 survived as well as two out of the 30 flaps of group 5. Four of the 15 flaps of group 8 partially survived around the pedicule area. The venous vascularisation does not explain the survival of so-called venous flaps. The survival is increased by through-flow venous supply, and preservation of perivenous tissues.

Animals↗
PubMed1993

[Forum: reconstruction of the traumatic thumb. Esthetics and post-traumatic reconstruction of the thumb].

The authors deal with the aesthetic problems of traumatic thumb reconstructions from two complementary points of view: surgical and psychoanalytical. From the surgical point of view, they discuss the aesthetic factors of repair ("aesthetics equals function") in the hand and in the donor site. The features of a "good" reconstructed thumb are recalled, together with the ways of achieving this result, taking into account several imperatives related to the various techniques: the residual scar, the proportions of the thumb (length and diameter) and the appearance of the nail. The morphological sequelae at the principal donor sites (hand, forearm and foot) are also evaluated. Although sacrifice of the great toe is not longer justified, that of the second toe should be weighted up against the limited sequelae of "custom-made" great toe flaps. In the second, psychoanalytical approach to the aesthetic problem, the deep motivations underlying the patient's request are examined. In order to satisfy the patient's demand, it is essential to clearly define the indications and contraindications related to the patient's psychological make-up, the importance of the aesthetic role of his or her hand and the psychological impact of both the initial trauma and the secondary sequelae of surgery, bearing in mind that psychological factors change with time, just as the body image also varies continuously. Finally, the dual, surgical and psychoanalytical approach should allow the surgeon to satisfy the hand injury patient's functional and aesthetic demands under the best possible conditions.

Amputation, Traumatic↗