The Gigogne flap: an original technique for an optimal pulp reconstruction.

The reconstruction of digital pulp defects is still a challenge in hand surgery. Several reconstructive techniques are available, but in some cases, their advancement capacities are not sufficient for the flap to cover the whole defect. The Gigogne flap is a new, very simple and safe technique.

Temporary ectopic digital implantation: a clinical series of eight digits.

This paper reports our experience with temporary ectopic digital implantation. Four patients suffered 12 digital amputations with large defect over the proximal stumps. Only 8 digits were suitable for microsurgical salvage but the local conditions made direct replantation impossible.

[Why think about tendons allotransplantation in hand surgery in 1989?].

Two cases of a human vascularized allotransplant of a complete digital flexion system are reported with detailed descriptions of the dissection technique and postoperative treatment. Satisfactory functional results open new prospects for this type of transplantation surgery.

A fresh look at vascularized flexor tendon transfers: concept, technical aspects and results.

The authors present the results of their surgical experience based on an original approach in secondary reconstructing 71 flexor tendons of the hand. For 20 years, they have been using vascularized tendon transfers either islanded or as free transfers. Their techniques are based on extensive knowledge of the sliding mechanisms involved around the flexor tendons, for which the authors have developed new scientific explanations resulting from their observations and the fine analysis of movements.

[Salvage of digits replantations by direct arterial antithrombotic infusion].

At the end of the seventy, we saw the reconstructive microsurgery developed to such an extent that it became a new and an independent surgical specialty. The development of the microsurgical instrumentation and the description of the surgical anatomy allowed the application of this technology to the most complex plastic reconstructions and particularly to the replantation of the amputated digits, especially the very distal digital amputations. Nowadays, the indications of digital replantation are well-defined according to numerous parameters conditioning the anatomical result and the functional outcome.

[The dorsoradial flap: a new flap for hand reconstruction. Anatomical study and clinical applications].

The authors report a new cutaneous flap harvested from the dorsal and distal quarter of the forearm: the dorsoradial flap. The vascularisation type of the cutaneous paddle belongs this flap to the anterograde and axial family flaps. The anatomical study carried out on thirty six fresh cadaver upper arms showed a constant and a consistent cutaneous collateral branch of the radial artery which arises at the apex of the first intermetacarpal space.

[The Omega "Omega" pulley plasty. A new technique to increase the diameter of the annular flexor digital pulleys].

The authors report a new technique of pulley plasty of the flexor digital system. It is not an operative procedure to reconstruct a damaged pulley but an original way to expand the volume of an intact pulley in order to adapt its volume to the diameter of the repaired flexor tendon. The flexor tendons ruptures in Verdan zone II and particularly in Tang zones IIA and IIB are often accompanied by an osteofibrous tunnel injury.

[The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease].

The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons.

[Salvage of amputated digits by temporary ectopic implantation].

We present two clinical cases with complete amputation of multiple digits that were salvaged after having been successfully implanted on ectopic sites. The first case concerns a 73-year-old patient, who suffered a severe crush injury of his right hand that resulted in amputation of all four long fingers and an extensive tissue loss of the palm and the dorsum of the hand. Two of the amputated digits, that were considered to be replantable, were implanted on the dorsum of the left foot.

[Introduction to the knowledge of subcutaneous sliding system in humans].

The mobility of our body structures is so intrinsic and natural to us that we tend to take it for granted. The very fact of being able to pinch your skin and lift it, then let it go and see it return to its initial shape and texture in just a few seconds may seem banal enough until you begin to think of all the elements involved. The same is true when you bend your fingers and think of the movement of the flexor tendon across the palm without external translation.

[Simple and composite ulnar transplants in reconstructive surgery of the hand].

Over several years, the authors have devised a technique for compound island transplants of ulnar origin, harvested from the forearm's lower third, with reverse flow vascularization. Because of the variety of arterial ramifications, these transplants can consist: either of a simple cutaneous, superficial flexor tendon or ulnar fragment transplant, or, when associated, of compound cutaneous-tendinous, cutaneous-osseous and even cutaneous-tendinous-osseous transplants. These transplants, based on the clinical experience of 192 cases, can be used by retrograde rotation for a variety of indications, such as loss of skin cover, digital surface reconstruction or treatment of scaphoid pseudoarthrosis.

Mesovascularized island flexor tendon: new concepts and techniques for flexor tendon salvage surgery.

Hand surgeons have long sought ways of avoiding adhesions in flexor tendon repair. We report a new concept in tendon surgery--the use of flexor tendons with perfect mesotendon blood supply and an inherent gliding mechanism composed of the paratendon and the common carpal sheath to minimize adhesions during tendon healing. This technique, inspired by reversed ulnar island forearm transfers, makes use of the flexor superficialis of the ring finger, which is supplied by a vascular mesotendon emerging from the ulnar pedicle just before Guyon's canal, and ensures a perfect blood supply, a favorable environment for suturing, and, consequently, impressive digital excursion.

Human allotransplant of a digital flexion system vascularized on the ulnar pedicle: a preliminary report and 1-year follow-up of two cases.

Two cases of a human vascularized allotransplant of a complete digital flexion system are reported with detailed descriptions of the dissection technique and postoperative treatment. Satisfactory functional results open new prospects for this type of transplantation surgery.

Recalcitrant non-union of the scaphoid treated with a vascularized bone graft based on the ulnar artery.

Eight patients who had a recurrent pseudarthrosis of the carpal scaphoid were treated by a bone graft from the ulna, vascularized by an ulnar-artery pedicle. The graft was taken from the medial aspect of the distal third of the ulna and inserted into the prepared scaphoid. This technique is advocated only for complex recalcitrant non-union.

The reverse ulnar artery forearm island flap in hand surgery: 54 cases.

The authors discuss their experience with the ulnar artery forearm island flap in 54 cases of hand surgery. They discuss its advantages over the radial island forearm flap and examine further technical possibilities in hand reconstruction, such as the compound flap. Although these reconstructive techniques do not have any sequelae, they involve the sacrifice of a major artery and should thus be used only in complex cases with very clear indications and as a last resort.

Microvascular free bone transfer: experimental technique on rat's femur.

A technique of microsurgical femur transplantation on rats is presented. This experimental model is used for better understanding of the bone physiology in autotransplantation and in homotransplantation.