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Biomedical subjects

P Vichard

Publications and source records attributed to P Vichard.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Reflections on 4 cases of ante-lunar carpal luxations].

Over the past 20 years, 4 cases of ante-lunate carpal dislocation have been treated in the Traumatology and Orthopaedics Department of Besançon. During this same period, 61 cases of retro-lunate dislocation have also been treated. Ante-lunate dislocations are very rare lesions as confirmed by a review of the literature. Our cases do not illustrate the mechanisms of such injuries since 3 cases involved patients with multiple injuries Clinical symptoms may be very minor in children in whom such injuries may easily be overlooked. A thorough interpretation of X-rays is necessary for diagnosis in adults. All 4 cases showed a fracture of the lunate in a frontal plane (factor of instability). Such an instable lesion justifies either internal osteosynthesis or percutaneous trans-articular pinning when rigid internal fixation is impossible. However, in all cases in which the lesion was treated surgically, the capsular plane was not disrupted. Retrospectively, such a finding contraindicates an open surgical approach. Relationships between such dislocations and isolated fractures of the lunate are discussed. The prognosis is mainly determined by early diagnosis and management rather than the type of treatment itself.

Accidental Falls↗
PubMed1991

[Glomus tumor of the sciatic nerve].

Nervous glomus tumor is an exceptional lesion, as only one case has been reported in the literature. A case of sciatic nerve glomus tumor is described. Because of the intra-neural location of the tumor with complete loss of the fascicular structures, the tibial nerve was resected and grafted. Light microscopy clearly demonstrated a glomus tumor; the histological features of these cells are typical of this lesion.

Adolescent↗
PubMed1991

[Role of a "watch and wait" policy in the treatment of blunt traumatic lesions of the spleen in adults].

Modern imaging has considerably modified our therapeutic indications, as it allows appreciating the nature of traumatic lesion s of the spleen. We now know that part of the damage sustained by this organ does not evolve towards major internal hemorrhages. In addition, it is advisable to avoid splenectomy, which entails its own complications. It is therefore justified, not only to preserve the spleen, but also to perform no laparotomy whenever this is possible. A series of 22 injured patients, following several isolate cases of "watch and wait policy", confirms the validity of our attitude.

Adolescent↗
PubMed1991

[Procedures for repairing skin losses of the knee with joint exposure].

The authors analyse the various procedures for covering skin defects at the knee region exposing either the bones or the joint. Actually, various local flaps allowed in most cases coverage in this area using either a pedicular muscle flap or fasciocutaneous, or even an island flap. For every local flap, its vascularisation, its technique of elevation and its arc of rotation are described. Occasionally, free flaps or cross leg flaps have been used. Indications depended on the patient age, topographic size of the defect, time of covering in emergency or secondarily, trophicity of the surrounding soft-tissues and also the eventual associated vascular injuries.

Humans↗
PubMed1990

Closed traumatic rupture of the ring finger flexor tendon pulley.

We report an unusual case of closed traumatic rupture of the ring finger flexor tendon pulley not previously reported in the literature. This injury occurred in a 21-year-old athlete during rockclimbing. Lack of flexion of the distal interphalangeal joint was accompanied by a palpable subcutaneous cord on the palmar side of the proximal phalanx. A simple repair of the pulley was done. The postoperative functional result was satisfactory.

Adult↗
PubMed1990

[Carpal tunnel syndrome before 20 years of age. A report of 7 cases].

Seven cases of carpal tunnel syndrome before 20 years old are described: 4 were associated with an increase in the patient's athletic activities. In five cases, no etiology was found, marked median nerve stenosis was observed in three cases and hypertrophy of the median nerve was observed in two cases. Flexor retinaculum was thickened in four cases.

Adolescent↗
PubMed1990

The treatment of avulsion fractures of the tibial tuberosity in adolescent athletes.

Avulsion fractures of the tibial tuberosity occur mainly during sport activities and are closely related to the strains exerted on the anterior tibial tuberosity by the extension complex of the thigh. A knowledge of the mechanical aspects of these avulsions may improve understanding of the mechanisms of such injuries. In such avulsion fractures, tensile forces due to the contraction of the quadriceps complex overcome the cohesive forces within the apophyseal cartilage. A 1-month cast immobilisation on an extended knee gives good results in the management of nondisplaced fractures. In minor displacements, such immobilisations follow closed external reductions. Open reductions and stable screw fixations precede a 3-week immobilisation for displaced fractures. Long term results are regularly good in well-managed cases.

Adolescent↗
PubMed1990

[Tangential injuries and hematoma. Application of liposuction combined with biological glue].

The authors report an unconventional method of management in hematomas complicating tangentiel trauma. They use the application of liposuction within the first days, this procedure allow complete removal of the clots. It is associated with a biological glue sprayed all over the skin detachment. This simple operative technique is carried out under local anaesthesia and minimizes the recurrence of hematoma. The long term morphological result is satisfactory, avoiding the sequelae of conventional procedures.

Hematoma↗
PubMed1990

[Free-flap transfer of the omentum to the lower leg].

The authors describe an unusual procedure for closure of a large skin defect of the lower limb exposing the tibia. Due to the severity of the vascular and cutaneous lesions, a greater omentum free flap was used with micro-anastomosis onto the contra-lateral leg: heeling was satisfactory after release of the flap.

Female↗
PubMed1990

[The teaching of surgical specialties in France to foreign students: apropos of an inter-university specialty diploma in orthopedic surgery and traumatology].

Foreign doctors who wish to be specialised in a particular branch mainly register themselves for a D.I.S. (Specialised Inter-university Diploma). The curriculum to this diploma is described through its Orthopaedics and Traumatologic Surgery branch and its drawbacks are analysed, namely lack of strict selection at entrance, insufficient theoretical courses and specially lack of practical training. More over, figures concerning the first batch show a large number of students registered in the first year while only a few succeeded the final examination. The consequences of such a poor formation might be serious. Solutions are proposed after comparison with the organisations retained in other countries. Any reform should firstly describe the aims of this postgraduate educational programme to foreign students.

Curriculum↗
PubMed1990

[Pedal cutaneous island flap. Apropos of 6 case reports].

The authors report their experience using the dorsalis pedis island flap, described by MacCraw, for coverage of soft tissue defects of the heel, and both lateral and medial areas of ankle. The operative technique is recalled and six cases are presented. The authors analyse the several indications of the island flap. Its disadvantages are emphasized.

Adolescent↗
PubMed1990

[Spiroid fractures of the thoracic and lumbar spine].

The review of our observations of fractures of the thoracic and lumbar spine (588 files could be used from 1969 to 1989) allowed us to demonstrate fractures not included in the usual classification. In our opinion, the fracture line is spiral. The mechanism therefore includes a very likely axial rotation. The fracture line may be confined to the vertebral body (this is the type called S1) or extends to the posterior arch as well (S2 type). The fractures often cause nerve root lesions. However, no complications involving the cord were noted in our series, even in the few cases showing considerable displacement. Note the tendency to axial telescoping of the focus, which requires specific modalities of treatment.

Adult↗
PubMed1989

Surgical treatment of epidermolytic hereditary palmoplantar keratoderma.

We report the case of a man with epidermolytic hereditary palmoplantar keratoderma. After failure of topical and systemic therapy, excision and skin grafting of both hands was done in several steps. Attention must be given to the skin-repair procedures (split- or full-thickness grafting), and the exact setting of the suture lines in the fingers is important.

Adult↗
PubMed1989

[Chronic instability of the metacarpophalangeal joint of the thumb without arthrosis. Apropos of 16 cases].

A series of 16 cases of chronic instability of the metacarpo-phalangeal joint of the thumb is presented. The authors begin by summarising the two main surgical procedures used in such cases: ligamentous reconstruction and arthrodesis. In our series, a ligamentous reconstruction with Smith's procedure was performed in 13 patients, a primary arthrodesis in 2 patients and a secondary suture in one patient. The results are analysed in 15 patients (7 women, 8 men) with a minimum followup time of two years. Failure was noted in 4 cases treated by ligamentous reconstruction (3 men and 1 woman). An arthrodesis was subsequently performed in all these patients. There were therefore a total of 6 arthrodesis and 8 ligamentous reconstruction to review. Ligamentous reconstruction gave better functional results than arthrodesis in particular as regards mobility, opposition of the thumb and strength of pinch grip (decreased by 50% with arthrodesis). In manual workers the use of ligamentous reconstruction in these cases was shown in our series to give inconstant results.

Adult↗
PubMed1989

[Spinocellular epithelioma of the hand. Apropos of a diffuse and extensive commissural form].

The authors report a case of squamous cell carcinoma of the hand unusual because of its very rapid extension: A 64 year old man was referred to us for treatment of a keratoacanthoma located in the thumb web (histological diagnosis on two occasions). In fact, the histological frozen-section examination at the time of surgery revealed a well differentiated squamous cell carcinoma. A wide excision of the tumor was carried out together with amputation of the index finger according to Chase's technique. Axillary lymphadenectomy was performed due to clinical evidence of regional lymphatic spread (large node) twenty one days following surgery. Four months later, a recurrence in the thumb web required radiocarpal disarticulation. Three months later, a new recurrence at the stump, spreading to the forearm, necessitated an above-elbow amputation. In relation to this unusual case, the authors emphasize the importance of initial diagnosis and the difficulties of surgical management of this tumor, especially in palmar and web or deep locations.

Amputation, Surgical↗
PubMed1989

[Verneuil's disease. The diffuse inguino-perineo-gluteal and bilateral axillary form].

The authors report a case of suppurative hidradenitis of unusual severity affecting the axillary, inguinal, perianal, genital and sacral areas. The surgical treatment consisted initially of large excision of the axillary areas. A musculo-cutaneous latissimus dorsi island flap was then used to cover the defect. 45 days later, a complete excision, in only one operative session, of the inguinal, perianal, genital and sacral area was performed, associate durth colostomy. A mesh graft was performed 15 days after the excision. This procedure allowed an early scar.

Apocrine Glands↗
PubMed1989

[Recent peri-lunate dislocations of the wrist].

The authors analyse a series of 50 fresh dislocations of the carpal-lunate. 35 of these patients were reviewed clinically and radiologically: the radial peri-lunar dislocation is more often encountered than described in the literature. Lunate necrosis and collapse is rare and there is no relationship between secondary necrosis of the lunate and primary dislocation. The clinical results, with a mean time follow-up of 5 years and 6 months are good, but radiological abnormalities such as arthrosis and instability are seen without clinical complications. The authors present their management of dislocation of the carpal lunate but it seems that early diagnosis and treatment of these dislocations is essential for good results.

Carpal Bones↗