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Biomedical subjects

P Voche

Publications and source records attributed to P Voche.

32 records · Page 2Linked to original sources
PubMed1994

[Injuries of the flexor tendons of the hand].

Diagnosis of clear-cut severing of the two flexor tendons is simple and obvious. This is not true for isolated injury to a single tendon and for partial severing. In this case, careful clinical examination and routine surgical exploration of any wound with regard to the course of the flexor tendon is required. Surgery should aim at the least traumatic repair possible, followed by specialised rehabilitation directed by the surgeon. In the distal region, reinsertion into the bone is required. In other regions, suture consists of a the main suture with a continuous suture of the epitendineum. The region of the digital canal requires rigourous care due to its specific anatomy. The corollary to good surgical repair is rehabilitation, understood and complied with by the patient. Early mobilisation procedures are used predominantly in order to avoid the formation of postsurgical adherences.

Hand Injuries↗
PubMed1994

The homodigital subcutaneous flap for cover of dorsal finger defects.

The authors propose a volar subcutaneous pedicled flap to cover skin defects over the dorsum of the same finger. This flap includes all the subcutaneous (adipofascial) tissues from the reticular dermis to the synovial sheath of the flexor tendons. After elevation of the dermo-epidermal flap, the subcutaneous tissues are raised as a flap pedicled laterally on one of the collateral arteries which constitutes the axis of rotation and transposition. After release of the collateral neurovascular bundle from its connections with the skeleton, the skin and the synovial sheath, the flap can be transposed to the dorsum of the finger and then covered with a split thickness skin graft. The advantages of this technique are: (1) No functional or cosmetic sequelae at the donor site which is closed by the volar dermo-epidermal flap; (2) Homodigital flap. This is particularly helpful in cases of multidigit involvement where cross-finger flaps cannot be performed; (3) Vascular reliability; (4) Preservation of both collateral arteries.

Adult↗
PubMed1994

[The "star": a design principle of antebrachial radial fasciocutaneous flap. Technical note].

In performing a fasciocutaneous radial forearm flap to cover the dorsum of the hand, the authors suggest to draw the flap as an eight-tip star. This technical tip allows to minimize the centripetal skin healing process at the recipient site (currently observed in case of circular or ovoid defect) and to reduce the scared aspect at the donor site, by first closing of the four cardinal tips.

Burns, Chemical↗
PubMed1994

[Microsurgical coverage of proximal amputation of the forearm. Functional value of preservation of the elbow joint].

The authors reported three traumatic cases of below-elbow amputation. The proximal squeleton of the forearm was bare-exposed and the replantation was not done due to the mechanism of the injury. To preserve the function of the elbow joint which the main components were safe, the soft tissue coverage was realized by a musculocutaneous latissimus dorsi free flap in each case. A body-powered forearm prosthesis was adapted for the three patients who were able to return to an adapted job in an average time of 8 months. The importance of the preservation of the elbow joint to improve the function in upper limb amputees is discussed.

Adult↗
PubMed1993

[Arthrodesis of 4 bones of the wrist. Study of 12 follow-up cases].

From November 1988 to December 1990, 15 four-bone fusions (capitalum-lunatum-triquetrum-hamatum) were performed in our department. 3 cases were lost at follow-up, so we here describe 12 cases reviewed for a clinical and radiologic evaluation. Etiologies were as follows: advanced scapholunate dissociation: 5 cases; advanced pseudarthrosis of the scaphoid: 6 cases; ulnar midcarpal instability: 1 case. Follow-up averaged 18.8 months with a range of 6 to 29 months. Pain was significantly lessened: 9 patients had either no pain, pain influenced only by weather, or pain after sustained effort. Results for strength were average. Joint motion was severely restricted, with individual variations among patients. Remaining joint motion was of little use, and some activities of daily living were thus hampered. Pre and postoperative radiologic analysis of the carpus showed that repositioning the proximal row into the distal row of bones was not necessary. In order to obtain a good result, it suffices to stabilize the existing carpal collapse without attempting to restore carpal height. Study of this short series showed the efficacy of this arthrodesis as regards to pain although it significantly decreased the range of motion.

Adult↗
PubMed1993

[Correction of posttraumatic disorders of the distal radio-ulnar joint with the Sauvé-Kapandji surgical procedure].

The Sauve-Kapandji procedure was performed on 21 patients with posttraumatic lesions between May of 1985 and May of 1991; average clinical and radiological follow-up was 3.4 years. Causal mechanisms were as follows: 12 cases were sequelae of fractures of the distal extremity of the radius; 5 cases were sequelae of fractures of the diaphyses of the two forearm bones and/or of the head of the radius; 2 cases of instability of the distal radio-ulnar joint; 2 cases of posttraumatic isolated arthritis of the distal radio-ulnar joint. Subjective evaluation by the patients of the results of surgery was as follows: 8 excellent, 6 good, 2 satisfactory and 5 poor. The most consistent improvement was a gain of mobility in pronation and supination which averaged 87 per cent of that of the healthy contralateral side. Nine patients were free of pain, 6 experienced some pain only during effort, and 6 still suffered constant pain. Grip strength was the factor that changed the most: it averaged 55 per cent of that of the healthy contralateral side. Indications for the Sauve-Kapandji procedure and its results in posttraumatic lesions are discussed. This procedure is compared to other techniques used to correct posttraumatic disorders of the distal radio-ulnar joint.

Adolescent↗
PubMed1993

[Arthrolysis of the wrist, indications and technique].

The authors describe a technique of arthrolysis which can be used on the palmar aspect of the wrist, on the dorsal aspect, or on both capsular and ligamentous complexes. The procedure must not be performed before inflammation and retraction phenomena of capsular and ligamentous complex have completely ceased. The surgical procedure must be followed rigorously but is not especially difficult. Criteria for patient selection are emphasized because proper indication is crucial to ensure satisfactory results.

Adult↗
PubMed1992

Scapho-trapezio-trapezoid arthrodesis in the treatment of Kienböck's disease. A study of 16 cases.

Sixteen scapho-trapezio-trapezoid arthrodeses were performed for Kienböck's disease. In ten cases, a prosthetic replacement of the lunate was inserted at the same time. Clinical results were good with regard to pain and fair with regard to grip strength which was improved by an average of 32%. In contrast, the arc of flexion-extension was 38% less than on the unoperated side. Long-term radiographic assessment showed the efficacy of the procedure in maintaining carpal height. Biomechanical observations and a review of poor results showed the limits of the method and the importance of correct positioning of the scaphoid. We concluded that triscaphe arthrodesis was a useful procedure for the treatment of Kienböck's disease in Decoulx's stage 3.

Adult↗
PubMed1992

[Use of intraosseous resorbable implants. Experimental evaluation and clinical applications in hand surgery].

The authors report about their experience with the use of absorbable intramedullary nails. After an experimental phase comprising mechanical tests and animal experiments in rabbits, the first clinical applications were for 24 cases of metacarpophalangeal arthrodesis of the thumb. For this indication, bone stabilization was achieved by associating an absorbable intramedullary nail and a metallic oblique pin. Evaluation in animals included, on one hand, a magnetic resonance imaging study, and on the other hand a histological study after the staggered sacrifice of the animals. This histological study was performed on non-decalcified bones by inclusion in methyl methacrylate resin. The mechanical results confirmed the appropriate resistance of these materials for use in the digital skeleton. The histological assessment showed that absorption begins around the 4th month by progressive fragmentation of the material and lasts over 3 years. The encouraging clinical experience and some obstacles encountered during its implementation hav led to two modifications: on one hand, a larger nail was used, on the other hand an absorbable oblique pin was developed, thus ensuring a fully absorbable osteosynthesis.

Adult↗
PubMed1991

[Scapho-trapezo-trapezoidal arthrodesis or triscaphe arthrodeses. Study of 36 reviewed cases].

From May 1983 to September 1988, we performed 41 triscaphe arthrodeses, 36 of which underwent clinical and radiologic follow-up examination. The 36 preoperative diagnoses were classified as: Kienböck's disease (16 cases), chronic rotatory subluxation of the scaphoid (static scaphoid-lunate dissociation) (13 cases), degenerative arthritis of the scapho-trapezio-trapezoid joint (4 cases), traumatic lesion of the scapho-trapezio-trapezoid joint (2 cases), 1 case of midcarpal instability with a non-dissociative VISI pattern. Average length of follow-up was 28 months. Analysis of results showed on the whole good improvement on pain and average improvement of strength; range of motion varied greatly with etiology. For example, the range of motion on the fused side in Kienböck's disease averaged 38 per cent of that of the unoperated side, whereas in other conditions it averaged 60 per cent. Radiographic analysis confirmed the efficacy of triscaphe arthrodesis in preserving normal carpal height but revealed radial styloid impingement in 34 per cent of the cases. Use of this procedure should be limited to stage 3 Kienböck's disease and to scaphoid-lunate dissociation without arthritis. Peroperative radiographic study is indispensable to verify appropriate reduction of the scaphoid and to measure the radial-scaphoid angle. Partial radial styloidectomy should be included routinely in the procedure.

Adult↗
PubMedDate not supplied

[Medical and surgical management of septic diabetic foot].

Infected wounds in diabetic patients are still frequent and the main cause of amputations. The experience of 180 patients admitted for foot lesions between june 1988 and september 1993 shows us the importance of combined medical and chirurgical cares. Non invasive vascular evaluation is reliable and often sufficient for preoperative vascular assessment. Total excision of infected and necrotic tissues is essential for the control of septic conditions. Conservative surgery can be considered a possibility as atypic amputations and adapted footwear may allow quick recovery and early walking. Resigned attitudes and pejorative outlooks are out-of-date, when faced with a diabetic foot problem. Optimal metabolic control and full preoperative assessment guide surgical possibilities.

Abscess↗