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Biomedical subjects

G Foucher

Publications and source records attributed to G Foucher.

At least 19 recordsLinked to original sources
PubMed1992

Distal and very distal digital replantations.

Ninety-five patients with 98 complete or incomplete amputations of digits are reviewed. Three levels are considered according to the bony lesion, zone III being distal to the nail matrix. In this area, artery, nerve and vein repair need special techniques. The use of leeches in the absence of vein repair does not preclude an acceptable survival rate (68%), compared to the overall series (65.5%); however, smoking is detrimental (52%). Distal replantation is a fast and worthwhile procedure providing acceptable sensibility, no PIP limitation and good appearance at the price of a mean 74 days off work.

Amputation, Traumatic↗
PubMed1992

[Tendinitis of the palmaris longus muscle. Apropos of 24 cases].

Twenty-four cases of flexor carpi radialis tendinitis were diagnosed between 1985 and 1989 by SOS Main Strasbourg. This condition typically occurs in women (75%) with a mean age of 47 years with no particular occupational activity who present with spontaneous and induced pain along the distal part of the tendon. Examination may reveal disturbances of cutaneous sensation in the territory of the palmar cutaneous branch of the median nerve and associated signs: cysts (10/24 cases), scapho-trapezium osteoarthrosis (3 documented cases). Medical treatment provided good results in 7 out of 9 patients reviewed after a mean follow-up of 15 months. In the event of failure, surgical treatment with opening of the compartment, provided 4 good results in 6 patients reviewed after a mean follow-up of 2 years 4 months.

Adult↗
PubMed1992

[The carpal bump].

Fiolle reported the first description of a "carpal boss". The "hump" is cosmetically disturbing and sometimes painful. It has to be distinguished from a ganglion. A lateral X-Ray with 30 degrees of supination reveals a spur or a styloid bone (12.5%). In a series of 44 patients, treated over a period of 7 years, 21 needed operation for pain or a complication of previous surgery. The technique described by Cuono and Watson was successfully used without recurrence of deformity but in 2 cases some pain remained during strenuous efforts.

Adolescent↗
PubMed1992

Open palm technique for Dupuytren's disease. A five-year follow-up.

One hundred and seven patients presenting 140 localizations of Dupuytren's disease were operated upon by a single surgeon before 1985, according to a modified Mac Cash procedure combining a Bruner approach and open transverse digital and/or palmar incisions. All surgery was performed under axillary block on an out-patient basis. A striking feature is the absence of complications such as haematoma, skin necrosis or infection. In the early post-operative follow-up (mean 105 days), the average angular improvement was 79.5% in all patients. Among the 107 patients, 54 (for a total of 67 localizations) were specifically reviewed with an average follow-up of 5.6 years. Improvement averaged 74% in 83.5% of digits. In the remaining 16.5%, the lack of extension averaged 31 degrees. Some factors had a negative effect on final results: early age of onset, major involvement of the PIP joint, localization at fifth ray level. The recurrence rate (41%, 23% of which severe) is identical to other reports on limited fasciectomy. A good indication is therefore a patient older than 50, and the method provided low postoperative morbidity and pain, associated with acceptable results.

Age Factors↗
PubMed1992

Forty-eight glomus tumours of the hand. Retrospective study and four-year follow-up.

We report a series of 48 glomus tumours of the hand, which have been reviewed with an average follow-up of 4.5 years (2-14). The tumour was nearly always sited in the distal digit, para-ungual (22 cases), more rarely subungual or under the pulp, with an even distribution among the fingers. Diagnosis was made preoperatively in 37 of 47 tumours of the digits, based on clinical features: consistent eliciting of pain by touch, less often by chill and occasionally accompanied by vasomotor phenomena. The pain and therefore the tumour could be accurately located with the tip of a pencil (Love's sign); these symptoms are abolished by inflation of a tourniquet proximally (Hildreth's sign). In 40% of cases a small defect in the distal phalanx is visible on plain radiographs, as well as an enlargement of the subungual tissues when the tumour is dorsal. The surgical approach was usually para ungual, in a sub-periosteal plane. Tumours were small (3.3 mm) and rarely multiple (3 cases). In 46 cases the pain was relieved quickly and definitively. Two true recurrences occurred after 5 years, without a satisfactory explanation. Except for those cases with transungual approach, there was no aesthetic compromise. We maintain that careful clinical assessment provides the diagnosis in most cases. Plain radiographs, lateral and comparative, are useful. MRI scan may occasionally prove of diagnostic value. The lateral ungual approach permits complete excision and healing. Recurrence is rare.

Adolescent↗
PubMed1992

The results of conservative management of trigger finger. A series of 169 patients.

The authors present the preliminary results of a series of 230 trigger fingers in 169 patients managed conservatively by injection of 1 ml of hydrocortisone into the flexor sheath as described by Curtis. 'Good' results were obtained after a single infiltration in 73% cases, after two infiltrations in 81.6% cases and in 83% cases after three infiltrations. Factors have been studied in order to identify variables with prognostic significance. The outcome was not influenced by the severity of symptoms, by the association with other disease, by sex or by the site of pathology. Outcome was affected by the duration of symptoms. Duration exceeding one year indicates surgical release as does failure of conservative treatment.

Adrenal Cortex Hormones↗
PubMed1992

MRI of hand and wrist with a dedicated low field mini imager: preliminary report.

In this paper we describe the development and the early results of an MRI system designed specifically for imaging of the hand and wrist. The imager takes up little space, uses a small 0.1 Tesla water-cooled electro-magnet with a vertical magnetic field and a 15 cm air gap. The system is based on a PC micro-computer and an integrated image processing board. There is no need for a Faraday cage. The image resolution is less than 1 mm using a 128 x 128 matrix format for a typical slice thickness of 3 mm. It is possible to achieve a 0.2 mm per pixel spatial resolution when imaging the fingers.

Hand↗
PubMed1992

[Denervation of the wrist].

Fifty patients with wrist arthritis mainly secondary to a scaphoid pseudarthrosis (44%) or a Kienböck disease (22%) were operated on by one surgeon by "total" denervation. With a post-operative follow up of 5 years, pain, strength and range of movement were reviewed. Four complications are by means of stressed: one painful neuroma and three radial nerve paresthesiae. 72% of the patients had pain improvement with an average of 72 points on a scale of 100 points. Strength and range of movement were not significantly improved.

Carpal Bones↗
PubMed1992

[Excision of the proximal row of the carpal bones. Apropos of 21 patients].

Twenty one patients have been reviewed with a mean follow-up of 4.6 years. If we except one acute case, the main indications were scaphoid pseudarthrosis (13 cases), Kienbock's disease (4 cases), carpal instability (3 cases) all accompanied by wrist arthrosis. The results were considered excellent and good in 65 per cent of the cases. Pain was improved in 90 per cent of the patients. Average mobility was 71 degrees (76 degrees before operation). Strength was improved in 19 per cent of cases but remained less than the normal side in 60 per cent. Among 15 manual workers 11 went back to the same work and 4 to an adjusted work.

Adult↗
PubMed1992

["Reposition-flap" technique in amputation of the finger tip. Apropos of a series of 21 cases].

The authors review 21 cases of a so-called "reposition-flap" technique for finger tip injuries consisting of simple reposition when no vessels can be found for replantation. This technique is combined with palmar soft tissue excision and advancement of a local flap to cover the bone providing blood supply and good sensitivity. The mean age in the 19 patients was 34 years. The Weber test was an average of 6 mm in the 17 patients with more than 2 years of follow-up. A moderate nail hook deformity was noted in 24% and cold intolerance in 28.5%.

Adolescent↗
PubMed1992

[Reconstruction of distal loss of substance in the nail-bed by a de-epithelialized flap from the digital pulp].

Twelve patients, presenting with traumatic avulsion of the distal nail bed, repaired by a de-epithelialized palmar advancement flap, were reviewed with an average follow-up of 23 months. Subjective results were considered excellent in two cases, good in seven, fair in two and poor in one patient. Nail adherence with the de-epithelialized flap was observed over almost 90% of the new nail bed. Nail dystrophy was observed in three patients, but was severe in only one. Two patients had slight curvature of their nail, while one had a severe hook-nail deformity. Mobility in the finger was always complete, and only one patient had a slightly decreased two-point discrimination on the flap.

Adolescent↗
PubMed1992

["Open palm" technique in Dupuytren's disease. Postoperative complications and results after more than 5 years].

From 1974 to 1988, 868 open palm and/or finger operations were carried out by a surgeon at the SOS Main emergent hand surgery unit in Strasbourg. Out of these, 107 patients making up 140 fingers were seen again after a period of more than 5 years. The essential advantage of the method is the low rate of postoperative complications relative to the other methods involving skin closure. All patients had an ambulatory treatment with regional anesthesia. The palm was opened in 85% of cases, and both the palm and the base of the fingers in 14%. The average healing time was 26 days, with an average sick leave of 28 days. Postoperative pain was noted in 20% of cases, requiring medication in 10% for an average of 3 days. Postoperative bleeding requiring new dressing occurred in one case, after the patient had already been discharged (0.7%), while 3.5% of all patients had anticoagulants. No hematoma and no flap necrosis were noted, and temporary dysesthesia was noted in 4.6% of cases, nerve involvement in 3.1%, and neurovascular dystrophy in 7%, including 4 only with a functional deficit (2.8%). On the other hand, results after 5-6 years are similar to those of selective aponeurectomies published in the literature, with frequent recurrence (40.6%, including 23% severe enough to require second surgery). Extension was noted in 39% of all cases, and the total activity of the disease was present in 55% of all studied hands.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Treatment of post-traumatic swan-neck deformities of the fingers. Apropos of a series of 43 patients].

Thirty three patients with 51 swan neck deformities were reviewed with a mean follow up of 35 months (6 to 86 months). 8 fingers presenting some stiffness necessitated a first step of splinting before operation giving nevertheless 5 excellent and good results. Among the other fingers with full range of passive motion surgery was performed in 38 cases with 81.5 per cent of excellent and good results. According to etiology, articular or extrinsic, excellent and good results were respectively 71 per cent and 94 per cent. The most frequently used operations were Littler type II (12 cases) and Littler type III (S.O.R.L. 11 cases) giving respectively 75 per cent and 82 per cent of excellent and good results, despite frequent minor complications. Tenodesis with translocation of a lateral extensor band gave in half the cases some extension lack at DIPJ (less than 20 degrees in 62.5 per cent). Finally direct surgery of mallet finger complicated by a swan-neck deformity led constantly to good correlation at the PIP level.

Adolescent↗
PubMed1992

[Total denervation of the wrist. Apropos of 50 cases].

Fifty patients who underwent a total denervation of the wrist were reviewed after an average of 5 years post-operatively. The main aetiology was diffuse osteo-arthritis secondary to scaphoid nonunion (44 per cent) and Kienbock's disease, stage IV (22 per cent). This resulted in pain and functional disability. Another surgical procedure was carried out in 40 per cent of patients. Post-operative complications included one painful neuroma and 3 patients complained of radial nerve paraesthesia. Pain was improved in 36 of the 50 patients with an average score of 72 over a scale of 100. There was no significant change in power or range of movement.

Carpal Bones↗
PubMed1991

Indications and results of skin flaps in painful digital neuroma.

Of the many procedures for treating painful neuromas, resection and proximal translocation are the most usual techniques, but these can decrease distal sensibility increasing deafferentation pain. In cases of intricate pain (nociception plus deafferentation), certain types of flaps allow the treatment of both components of the pain. We have used 30 such flaps in 28 patients: local flaps (exchange, advancement or lasso island flaps) and distant flaps (free "custom-made" toe flaps). The results of the different techniques provides 86.6% excellent or good results.

Adult↗