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Biomedical subjects

D Guinard

Publications and source records attributed to D Guinard.

At least 19 recordsLinked to original sources
PubMed2003

[Extensor digitorum muscle flap: its position in ankle and foot coverage. Report of 15 cases].

The authors report their experience about a 15 cases series of ankle and foot soft tissues defects reconstruction with the extensor digitorum brevis flap which demonstrates its advantages. The flap was elevated in 9 cases on the tibial artery while the 6 others were raised on the distal dorsalis pedis artery with a retrograde flow. Healing was obtained for all cases with a complete resolution of septic problems for the 8 concerned cases. The outcome was uneventful for all but one which presented with a partial skin donor site secondary necrosis. No functional or trophic problems were noticed in other cases. Elevation of the extensor digitorum brevis flap is simple without note-worthy sequelaes. It is a reliable technique either for skin coverage or osteitis cure at level of the ankle. When raised with a retrograde arterial flow, it also appears as a useful alternative for the fore-foot reconstruction, location recognized difficult to treat by local means.

Adult↗
PubMed2000

PS-100 and NF 70-200 double immunolabeling for human digital skin meissner corpuscle 3D imaging.

For detailed study of complex structures such as corpuscular mechanoreceptors, confocal microscopy can be used with multiple immunolabeling that identifies specifically different subcomponents. In addition, anatomic interpretation is enhanced by three-dimensional reconstruction. Confocal laser micrographs, reconstructed from serial images 1 microm thick of human skin Meissner corpuscles simultaneously immunostained for neurofilaments (NF 70-200) and protein S-100 (PS-100), clearly reveal the complex 3D relationship between Schwann-related lamellar cells immunoreactive for PS-100 and the nerve fibers marked by NF 70-200. The nerve fiber, after branching into the corpuscle, divides into several ramifications, presenting discoidal expansions and flattened fringed sections. The mean nerve diameter was 4 microm +/- 1 (2-5 microm) and the mean size of the discoidal expansions was 15 microm +/- 1 (7-30 microm). Corpuscle size varied from 30-140 +/- 1 microm in length and from 20-60 +/- 1 microm in diameter. This study confirms the presence of neural discoidal areas in Meissner's corpuscles, which are probably involved to some extent with the transduction process. Despite the accuracy of immunolabeling and imaging, an extracorpuscular neural network was never observed in the vicinity of corpuscles, thus giving doubt as to their existence. (J Histochem Cytochem 48:295-302, 2000)

Adult↗
PubMed1999

The Mantero flexor tendon repair in zone 1.

Mantero and colleagues have reported a modification of the Bunnell pull-out method for the repair of zone 1 flexor digitorum profundus (FDP) lacerations that allows active postoperative mobilization. We report a series of 24 FDP lesions in 20 adult patients treated with this technique. The mean duration of the rehabilitation regimen, which was followed by all patients, was 4.2 months. Functional assessment using Strickland's criteria demonstrated 23 excellent to good results and one poor due to a septic rupture. Nineteen of the 20 patients were satisfied with treatment and all but one of the patients returned to work within an average of 2.6 months after operation. In comparison to other zone 1 repair methods with active mobilization regimens, the Mantero technique gives better functional outcomes and appears to be more reliable.

Adolescent↗
PubMed1998

Merkel complexes of human digital skin: three-dimensional imaging with confocal laser microscopy and double immunofluorescence.

Three-dimensional (3-D) reconstruction of images provided by confocal scanning laser microscopy (CSLM) is a powerful tool in a morpho-functional approach to cutaneous innervation studies. To investigate mechanoreceptors in the hand, a study of Merkel complexes was performed in human finger. A double fluorescent-conjugated immunolabeling with antibodies against neurofilament (NF 200) and cytokeratin (CK 20) on floating, thick cutaneous samples (80 to 100 microm), was used. After acquisition of serial optical planes by CSLM, reconstruction was performed with 3-D reconstruction software tools. Merkel cells were clearly labeled with CK 20, whereas nerve components were only NF 200 reactive. The cells, localized on the basal lamina of the epidermis, were usually arranged in clusters of five to eight cells. Each cell was connected to a nerve process ramification originating from a unique fiber. Quantitative data, compiled from a sample of 25 Merkel complexes, gave a mean cell diameter of 13 +/- 1 microm and a mean nerve fiber size of 3 +/- 1 microm. Surface measurements were done on a single reconstructed cluster with a mean and standard error which only refers to the optical 3-D resolution. It gives a surface of 12 +/- 1 microm2 for the contact zone between cell and nerve fiber and a cluster area of about 500 microm2. The great precision of reconstructed images provides a detailed analysis of spatial relationships between abutting nerve fibers and Merkel cells. Data interpretation is improved with complementary ultrastructural and physiological studies results, and this allows an accurate investigation of cutaneous sensory endings.

Antibodies↗
PubMed1997

Pins and Rubbers Traction System.

The Pins and Rubbers Traction System (PRTS) is a mobile frame created with wires to support elastic traction, which produces a ligamentotaxis effect in the same direction and of the same intensity whatever the position of the joint. This technique has been used in 11 cases of complex PIP joint fractures with eight excellent results. The advantages are simplicity, adaptability, the possibility of immediate mobilization, reasonable cost and relatively small bulk.

Adolescent↗
PubMed1996

[Neurocutaneous flap of the external saphenous nerve. A safe, easy and fast procedure for covering loss of substances of the ankle. A propos of 5 cases].

The distally based sural neurocutaneous flap is another procedure to cover the heel. It is an island flap based on the vascular axis of the sural nerve in the lower two thirds of the leg. The nerve is included in the pedicle after proximal section (it is therefore not a sensitive flap). The size of the flap, length of the pedicle, absence of vascular sacrifice, the simple procedure, and minor consequences at the donor site led us to use this technique five time over on period of four months with success.

Adult↗
PubMed1994

[Fractures and luxations of the thumb].

The integrity of the first carpometacarpal column determines the mobility of the thumb in space and thus opposition, a fundamental function of the human hand. Fractures and dislocations of this architecture can jeopardize its function. Joint lesions lead to instability or incongruity and subsequent post-traumatic stiffening arthrosis. Diaphyseal fractures can put out of axis or lead to abnormal rotation which impair the flexion and overall function of the thumb. Great attention should therefore be given to the anatomical reconstruction of these lesions. Open, unstable joint or periosteal fractures should be surgically reduced and a rigid fixation should be used. Dislocations require emergency treatment and in case of postreduction instability should be immobilized.

Emergencies↗
PubMed1994

[A comparative study of the "Levame" type extension splint and the "Low Profile" type extension splint: impact on therapeutic indications].

The most widely used dynamic extension systems, both to straighten the digital flexion retractions as well as to ensure directed mobilization after surgical repair of extensor tendons, are the so-called "Levame" and "Low Profile" splints. This study analysed the application of forces for these two types of extension splints, the directional constraints which they impose and freedom of joint movement which they allow in order to more clearly define the type of motorization to be used as a function of the most frequent indications.

Equipment Design↗
PubMed1994

[Restoration of opposition using the extensor pollicis longus. Apropos of 8 cases reviewed after 11 years].

Moutet and coll. had studied in 1986 a series of 16 cases of restoration of thumb opposition by extensor pollicis longus transfer onto abductor pollicis brevis through the inter osseous membrane. Eleven years follow-up revision of 8 of those 16 patients was performed by the authors. Indication of transfer was traumatic median nerve isolated palsy or associated to ulnar nerve palsy. Objective and subjective analysed parameters allowed to check the evolution of the transfer and to justify its indications. No transfer retraction has been noted in long term follow-up. The side effects of its removal (thumb retropulsion and MP extension defects) have minimum functional consequences. The opposition has been restored at the time of thenarians recovery and as well, each time the palsy was going on. In the cases where the thenarians recovered, the transfer became an antepulsion supply. The authors suggest to perform an opposition transfer, each time it is technically possible, in severe median nerve lesions, at the time of emergency operation.

Adolescent↗
PubMed1994

[A new titanium-carbon finger joint implant. Apropos of 15 initial cases].

Arthroplasty of the MP and PIP joint remains a therapeutic challenge for the hand surgeon. The poor results of the currently available implants are due to their mechanical conception (non strained) or their material (silicone causing instability, ruptures and silicone synovitis). The authors present the preliminary results of a new digital articular implant (IAD). It is a strained implant with a rigid hinge allowing 105 degrees of range of movement (0 degree to 105 degrees). Three sizes are available and very soon four. The intramedullary stems are in titanium alloy (TA6V) and the gliding surfaces in pyrolytic carbon. This association allows solidity, endurance, excellent gliding and no wear debris. 15 implants were evaluated (13 PIP and 2 MP joints) with a follow-up from 4 to 1 year. A painless range of motion were restored in 11 cases and 4 articulations were only lightly painful during motion requiring strength and at the end of the movement. The gain of the range of movement was 50 degrees always in a useful sector. The grasp was 60% better in post than in pre operative conditions. No infection was found. It is only the beginning of this implant but the indications seem to be good for all the articular destructions of the digital joints what ever was the aetiology (traumatic, infection or rheumatoid arthritis).

Adult↗
PubMed1994

[A proposal for a functional evaluation record for the hand].

Proposition of a new evaluation method included an analytic cotation, a functional cotation, and a cosmetic cotation. Use is speeded by the suppression of all kind of measure instrument and facilited by pictures. Application to the corporal damage evaluation.

Disability Evaluation↗
PubMed1994

[Use of an implanted electrode for rehabilitation after tenolysis of the flexor tendons].

The electric stimulation is widely used in flexor tenolysis rehabilitation by the authors. Since 1983 implantable electrodes were used during the operative procedure. Actually they gave better access to the deep muscles (Flexor Profundus of the index), better specificity, less dysesthesia of the skin. Further more they allowed to tests the quality of the tenolysis without wrist incision. This procedure gave 76% of good or very good results over 25 finders in 20 patients. The results were especially good for the index finger which is usually unable to be stimulated by the surface electrodes and for the fingers badly damaged. In this type of situation prognostic was getting better (70% of good and very good results).

Adolescent↗
PubMed1993

[Subcutaneous rupture of long finger flexor pulleys in rock climbers. 12 case reports].

Rock climbing generates a new type of microtraumatic, stress pathology involving all of the osteoarticular chain of the upper limb. The hand is the site of specific lesions: pulley ruptures (A2) are the most frequent. 12 top-level climbers (7a and above) were reviewed out of a series of 23 cases. In 7 cases, the ring finger was affected and in 5 cases the middle finger was affected. All cases were treated by rest and protection of the A22 pulley with an external rigid ring. Progressive return of climbing was allowed after the 45th day. The effects on the level of performance, residual pain and its consequences, and on associated lesions of the upper limb were investigated. 8/12 patients regained at least their previous level of performance and 6/12 no longer experienced any pain. 5/12 patients experienced minor pain which did not affect their level of performance. One patient had to stop top-level climbing because of persistent pain. Protection of the pulley, possibly combined with syndactylisation and complete rest, not only from sports activities, for at least 45 days are the best way of ensuring a satisfactory functional result in these particularly demanding subjects. Physiotherapy and non-steroidal anti-inflammatory treatment can also be combined.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

[Synthetic ligament reconstruction of the thumb metacarpophalangeal joint. 21 cases].

Since 1984, the authors have performed ligamentoplasties of the metacarpophalangeal (MP) joint of the thumb with Dacron mesh. A series of 21 cases is reviewed and tested clinically with a mean follow-up of 34 months. The MP joint remained stable. Loss of flexion of the MP joint was 30% of the healthy side. The mobility of the interphalangeal joint remained normal. Opposition ranged between 8 and 10/10 for 20 of the 21 patients. The mean overall reduction in strength was 30% on the dominant side and 20% of the non-dominant side. Apart from two failures by arthrodesis, all patients were very satisfied with their operation.

Adolescent↗
PubMed1993

[Protected early mobilization using Levame's device after primary repair of the extensor tendons of the hand. Apropos of a series of 88 cases].

Seventy patients with 88 lesions of the hand extensor apparatus were treated by primary repair followed by post-operative mobilisation with a dynamic steel blade splint (Levame). Results were good or very good in 97.7% of cases and moderate in 2.3% of cases for this series of simple lesions from zones 3 to 6. Prognostic factors influencing final result and wrist position during splint are discussed, the authors leave the wrist free for lesions in zone 3 and 4. Early mobilisation is the best treatment for tendinous lesions and a review of the literature confirms the validity of the author's choice. In spite of its biomechanical deficiencies, this simple technique may be used for non-disciplined patients and by non-specialized physiotherapists. For simple lesions of extensor tendons, the Levame splint may be considered as a real dynamic protective splint.

Adolescent↗