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Biomedical subjects

D V Egloff

Publications and source records attributed to D V Egloff.

53 records · Page 3Linked to original sources
PubMed1986

The cervico-thoracic outlet compression syndrome. Analysis of surgical treatment.

Surgical treatment of the thoracic outlet compression syndrome is being presently reconsidered. Until these last few years, there was the choice between two interventions only: scalenotomy, a simple operation entailing no complication, but with a 60% recurrence rate--or the resection of the first rib through an axillary approach, an efficacious intervention which caused, however, serious nervous complications in 14% of treated cases. The follow-up of 75 cases operated for a TOCS reveals to the authors that--all techniques taken into account--results are unsatisfactory in 33% of cases. These failures are due either to technical deficiencies, or to a complication arising in the course of the operation, or to an erroneous diagnosis. The authors resort to surgery only to treat serious vascular syndromes (absolute indication) or invalidating neurological compression syndromes, after failure of physical therapy (relative indication). They propose a cervical approach--the only one enabling a safe dissection of the brachial plexus--a partial scalenectomy, resection of all fibrous bands pressing on nervous trunks, or the resection of a cervical rib. Should the costo-clavicular space appear anatomically too narrow, the first rib, already partially freed by the cervical approach, will be resected through the axillary route.

Diagnosis, Differential↗
PubMed1985

Retrospective survey of seventeen toe transfers relation between surgical techniques and functional results.

The functional results of 17 toe transfers (15 second toes, 1 great toe and 1 monobloc second and third toes) are presented: arteries: 16 revascularisations achieved successfully out of 17. Veins: only one re-exploration had to be performed and it was successful. Osteosynthesis: performed in 10 cases with plate and screws, in 5 cases with a single K-wire and in 1 case with a double K-wire. No osteosynthesis was necessary in one case. Uneventful bone healing was always achieved. Tendons: the amplitude of movement at the interphalangeal joints (PIP & DIP) in post-traumatic cases is sufficient to ensure the desired function. In cases of congenital anomaly, however, the mobility of the transferred toe is almost nonexistent and function relies on the mobility of the recipient stump. Nerves: either discriminative or protective sensation was always obtained. Skin: in all cases adequate skin cover was obtained without resorting to a flap. Sequellae at the foot: there are virtually none when the second toe is removed. Various gait impediments occur, however, particularly on uneven surfaces, when the great toe or the monobloc second and third toes are removed.

Bone Plates↗
PubMed1985

[Free transplantation of the 2d toe. Technical features, problems and solutions].

On the basis of seven transfers of the second toe and one "en bloc" transfer of the second and third toe, technical features are discussed. The use of a plate for osteosynthesis is proposed. It has been found very useful, particularly when a MP-arthrodesis is performed between the first metacarpal and the second toe. It gives stability and therefore secondary displacement and/or rotation of the toe are avoided. It enables more accurate tension to be placed on the repaired tendons. For the flexor tendons it is suggested to repair the communis longus only, whereas both extensors, longus and brevis, and eventually the distal tendon of the lumbrical muscle should be sutured to avoid a PIP flexion contracture. In one case the revascularisation of the transfer was effected through the dorsalis pedis artery. In the seven other cases the digitalis plantaris communis I artery was used either as a substitute or as a complementary vessel. Under good conditions the repair of only one vein can be sufficient. Collateral plantar nerves as well as dorsal nerves must all be repaired. The use of fibrin glue for their suture is mentioned. A cutaneous defect is frequent on the lateral sides of the transferred toe. It can be first covered with Epigard and secondarily grafted after one or two weeks. That method was used in five out of eight cases.

Adolescent↗
PubMed1983

Pollicization of the index finger for reconstruction of the congenitally hypoplastic or absent thumb.

Between 1962 and 1980, 30 pollicizations of the index finger for congenital absence of the thumb were performed. None of the 30 index fingers were lost during the intraoperative or postoperative period. Of the 14 cases followed up on a long-term basis, six required secondary procedures, three for scar revisions; one, bone shortening; one, tenolysis of flexor tendons; and one, tenolysis of extensor tendons. All new thumbs showed normal sensibility. In four cases opposition was possible with all three residual fingers; in five cases, with the long and the ring finger; and in five cases, with the long finger only. Active motion averaged 42 degrees at the metacarpophalangeal (MP) joint of the new thumb and 35 degrees at the interphalangeal (IP) joint. The technique of pollicization has been modified over the years. Important steps are: correct skin incisions, complete destruction of the growth cartilage of the metacarpal head, fixation of the MP joint in maximum hyperextension, a rotation of 150 degrees, and the reconstruction of a musculotendinous shroud of the new thumb with the extrinsic and intrinsic tendons.

Fingers↗
PubMed1983

Nerve anastomoses with human fibrin. Preliminary clinical report (56 cases).

Since 1980, 56 peripheral nerve repairs have been done with fibrin. For technical reasons, combined anastomoses have been chosen in brachial plexus repairs (23 cases), fibrin alone being used in most other cases (8 free flaps, 17 main trunks, 8 digital nerves). As a whole, results compare evenly with the so-called classical repair methods using stitches. The adhesive method's main advantage is the gain in operative time, without impairing precision. Secondary benefits, such as hemostasis and easier stabilization of small grafts, can be achieved. One question remains: what becomes of fibrin? The survey of present cases would tend to prove that axonal growth through the second anastomosis is impeded proportionally to the length of the graft. The possible action of fibrin in the alteration process leading to a sclerotic diaphragm is not elucidated to this day. Experimental as well as clinical research must be carried on, in order to improve this new way of repairing nerves.

Adolescent↗
PubMed1983

Long-term results from metacarpophalangeal arthroplasty.

The authors have been using Swanson's prostheses for MP joint replacement in rheumatoid arthritis since 1968. After thirteen years of experience, they present an analysis of these prostheses from a clinical and radiological point of view. 88 joints replacements in 20 patients are reviewed. These operations were performed between 1968 and 1976. The average follow-up is nine years. The authors compare their results with those obtained in a previous study made in 1975. They show that a replacement arthroplasty with a Swanson type prosthesis, imparts considerable benefits to the patient in the form of complete disappearance of pain, improvement in function, and a more normal looking hand, in spite of radiologic deterioration.

Adult↗
PubMed1979

Immediate flap reconstruction after excision of basal cell carcinoma of the face.

The authors review 175 basal cell carcinomas of the face, treated primarily by surgery. The overall cure rate was 97%. Among these cases, 53 were treated by excision and immediate local flap reconstruction. Analysis of results in the latter group encourages the use of this method for virgin, untreated tumors provided basic rules of surgical oncology are followed. Furthermore, it has a definite advantage cosmetically over more conservative methods. If radiotherapy has been the initial treatment, however, immediate reconstruction after excision of a recurrent tumor should be contemplated reluctance.

Adult↗