[The stabilization in emergency of the complex open traumatisms of the wrist (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Merle.
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Microsurgery has brought important progress in the primary treatment of wounds of the hand. Microsuture of flexor tendons (Kleinert), revascularization by arterial and venous repair and bundle suture of nerves are all proven techniques which favour healing and functional recovery, provided early mobilization is instituted whenever possible.
The foot is an invaluable bank of spare parts available for reconstructing the mutilated hand. The dorsalis pedis flap, the extensor digitorum brevis muscle, and the first and second toes can now be used as free transfers. We believe that partial toe transfers, including either sensitive cutaneous flaps or composite tissue, are also extremely useful in properly selected patients.
Pre- and post-operative radiological appearances of various isolated congenital malformations of the hand are described, as observed in a personal series of 52 cases. Six groups of malformations can be distinguished, and are, in decreasing order of frequency: agenesias, syndactylies, duplications, amniotic bands, arthrogryposis, and macrodactyly.
A rather unusual case of a cartilaginous tumor of the soft tissues, without bone connections, is reported. The tumor was a chondroma developing from the extensor tendon sheath. The general characteristics of non-bony chondromas are described and similar observations reported in the published literature reviewed. Problems raised by differential diagnosis by radiological examination are discussed.
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The authors describe a modification of Hunter's technique of flexor tendon grafting. The operation is performed in two stages. At the first stage, a silastic prosthesis is inserted and the proximal end of the flexor digitorum profundus is sutured to the tendon of palmaris longus. This suture will represent the proximal suture of the future graft. At the second stage, six weeks later, the palmaris longus is divided proximally and the graft is passed distally to be sutured to the terminal phalanx. This modified technique allows a gain in time, a better blood supply to the graft and a safer proximal suture.