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Biomedical subjects

J Bakhach

Publications and source records attributed to J Bakhach.

15 recordsLinked to original sources
PubMed1999

Reverse dorsal digital and metacarpal flaps: a review of 27 cases.

Reverse dorsal digital and metacarpal flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks of the fingers. These flaps are transposed as reverse island flaps. Dissection of the flap is easy, fast, and preserves the collateral nerve and artery to the fingertip. A series of 27 flaps is reviewed, with more than 6 months of follow-up. Skin defects in all patients were located over or beyond the proximal interphalangeal joint as far as the fingertip and were combined with bone, joint, or tendon exposure. The flaps we used were reliable, and a joint or extensor tendon reconstruction could be performed at the same time. Patients were discharged the day after surgery and allowed to mobilize the finger early. No flap necrosis was observed, and donor site morbidity was minimal; primary closure or a skin graft was used in all patients. These flaps combine the advantages of an extended skin paddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects. When conventional local flaps are inadequate, this fast and simple procedure should be considered for its reliability and low associated morbidity.

Adolescent↗
PubMed1998

Extensor digitorum brevis muscle flap: new refinements.

Two original operative techniques of raising the extensor digitorum brevis muscle flap are presented. These methods allow for covering distal foot defects that are difficult to cover by other reconstructive means. In the first technique, the flap is based on an extended distal pedicle supplied by the dorsal interosseous artery of the first intermetatarsal space. In the second technique, the flap receives its vascular supply from the medial tarsal artery; this procedure may be valuable when the vascular supply of the dorsalis pedis pedicle has been disrupted. To confirm the availability of these vascular pedicles, cadaver dissections were performed and proved that the extended pedicle dissection enhances the rotation arc of the flap. Four selective clinical cases, in which the flap was successfully used, are discussed. Advantages of these techniques, in reconstructing large defects in the distal foot, are delineated.

Adult↗
PubMed1998

[Eponychial flap].

The author describes an original and new method to lengthen the fingernail plate in distal digital amputation. After digital amputation, the loss of substance concerns the pulp tissue and fingernail apparatus. Generally, most palmar falp techniques can restore functional and aesthetic pulp. The fingernail defect is obviously not tolerated by the patient and needs to be corrected. The eponychial flap is a backward cutaneous translation flap. This flap lengthens the nail plate and restores normal dimensions of the nail apparatus. Two clinical cases are reported. This technique should be reserved for reconstruction of stage I and II distal digital amputations.

Adult↗
PubMed1997

[Lateral brachial flaps].

The "extreme" lateral arm flap is a new method for covering the distal upper limb. This flap is a modification of the classical lateral arm flap allowing his transfer as a pedicled flap to cover the forearm and the wrist. This technique is based on a new concept: "the reverse flow VY pedicle advancement". This requires an arterial bifurcation of the deep humeral artery: the medial collateral artery described in this study.

Aged↗
PubMed1997

Reconstruction of the hand with forearm island flaps.

From all of the flaps reviewed, it is important to know how to select the most suitable choice in each case. Aside from the technical expertise of the surgeon, the indication depends on the size and the location of the substance loss. For large defects in any location, the radial forearm flap remains the most reliable and safest choice. For children and women, the authors prefer distant pedicled transfers or free flaps to minimize cosmetic donor site morbidity. For small or medium defects that cannot be managed by a local transposition flap, the indication is based on the location of the wound. Palmar defects, if proximal and ulnar, may be covered using the dorsal ulnar flap, with little morbidity in the donor area. The anterior interosseous flap seems a better choice whenever vascularized tendon, nerve, or bone are needed also. For the first web space and neighboring radial defects, the posterior interosseous flap provides a reasonable alternative. Dorsal defects of the hand can be reconstructed with a posterior interosseous flap, provided there is no suspicion of injury to the anastomotic dorsal system of the wrist. The anterior interosseous flap is a good choice for composite osteocutaneous transfers. For complex composite defects, the ulnar artery forearm flap distally based may be indicated for reconstructive problems requiring vascularized flexor tendons. The anterior interosseous flap is able to provide excellent quality vascularized bone. Indications depend above all on the surgeon's experience and on the different schools. As always, the better flap is that which is performed by the surgeon who has mastered the particular surgical technique. In conclusion, this article is devoted to an update on forearm flaps and illustrates the innovative strength of this specialty. It also points out that, through in depth knowledge of the anatomy, flaps may be raised from many anatomic regions of a limb without disturbing the main vascular axis of that extremity. Minimizing the donor site morbidity while maximizing the quality of the reconstruction is the primary concern when indications are established for reconstructive hand surgery, which is where one of the authors' main research efforts resides.

Forearm↗
PubMed1997

[Distal extensor digitorum brevis muscle flap. Report of 2 cases].

The authors describe an original technical modification of the extensor digitorum brevis muscle flap. As described, its use in a classical reverse flow manner allows the flap to reach only the metatarsophalangeal joints. The presence of the first dorsal interosseous pedicle offers the possibility to sacrifice the plantar anastomoses of the pedis pedicle and raise the flap on the vascular network of the first metatarsal space. The point of rotation is moved distally from the apex of the first metatarsal space to its base. The length of the vascular pedicle is substantially enhanced and enables the flap to cover all dorsal and palmar defects of the toes. Two clinical cases are showed. The advantages of this flap are discussed, particularly its indication in reconstructive surgery of the foot.

Adult↗
PubMed1996

[Ulnar parametacarpal flap. Experience with 10 clinical cases].

The parametacarpal ulnar flap is raised from the dorsal and ulnar aspect of the hand. It is vascularized by the distal division of the dorsal branch of the ulnar artery. The skin flap is innervated by the dorsal sensory branch of the ulnar nerve helpfull for the reconstruction of skin loss of the palm. At the level of the metacarpo-phalangeal joint of the fifth finger, the medial division is connected by a constant anastomosis with the fifth ulnar collateral artery. This anatomic disposition held the flap to be raised in two manners: as direct flow useful to cover the defects of the palmar aspect of the hand, or as reverse flow covering the defects of the fourth and fifth fingers. In this paper, the authors present an anatomic reminder and the surgical procedure. They report ten clinical cases and precise the indications of this flap in hand reconstruction.

Adolescent↗
PubMed1995

Bone growth after replantation in children.

Bone growth and the development of epiphyseal plates are disturbed after the replantation of amputated extremities in children, but the potential for continued skeletal growth is almost always maintained in the replanted part. In this reported series of 12 children, all younger than 15 years old, 13 amputated parts of the upper limb have been successfully replanted. After long-term follow-up (from 21 to 216 months), bone growth of the replanted parts was clinically and radiologically evaluated. Two different growing segments were distinguished: the proximal bone segment, directly injured from the initial trauma, and the distal replanted part. Average longitudinal growth recorded was 94.5 percent and 92.7 percent, respectively. Two young patients demonstrated overgrowth of the proximal bone segment, which attained 110 percent and 118 percent of expected growth. Although it is difficult to determine all the parameters affecting the prognosis of post-traumatic reactions in growing cartilaginous plates, the level of amputation is considered to be a significant prognostic factor for the epiphyseal growth of the replanted part.

Adolescent↗
PubMed1995

[Ulnar parametacarpal flap. Anatomical study and clinical application].

The ulnar border of the hand provides a new skin flap which is very useful in the reconstruction of defects of the palm of the hand and ulnar fingers. An anatomical study of the dorsal carpal branch of the ulnar artery and its various branches has led us to propose the ulnar parametacarpal flap either as a pedicle or free microsurgical transfer. The territory of the dorsal carpal branch of the ulnar artery allows harvesting of a simple sensitive skin flap or a composite flap comprising a bone or tendon island flap. Description of the distal communicating vessels with the ulnar collateral artery of the little finger extends the territory of the ulnar parametacarpal flap; based on a retrograde blood supply, it can reach the dorsal and palmar surfaces of the ulnar fingers. The authors present several clinical applications and define the place of this new flap among the various treatment options for the hand.

Hand↗
PubMed1995

[1984-1994: Ten years of skin flaps. Recent advances in experimental surgery].

The author has selected and updated four subjects in Plastic Surgery research. All flap monitoring procedures are detailed. They are still insufficient, as none of them can be used in all clinical situations. Free radicals have been implicated in the extension of necrosis after reperfusion of an ischaemic flap. Many substances have been tested for their scavenger action, particularly superoxide dismutase. Continuous intraarterial infusion of fibrinolytics is the treatment of the "no reflow phenomenon". A protocol with urokinasis, lidocaine and enoxaparine for ten days is used in our department with a 75% success rate. Finally, many interesting advances have been made to improve the biotolerance of allogeneic transfers. Cryopreservation of transplanted tissues at -196 degrees C for three weeks seems to be an interesting solution to avoid the rejection phenomenon.

Blood Gas Monitoring, Transcutaneous↗
PubMed1994

[The "extreme" brachial flap: a distal pedicled use of an external brachial flap. Preliminary report].

The authors present a new application of the procedure they called the "reverse flow YV pedicle extension" which allows a very distal pedicled mobilisation of the lateral arm flap. Until now, only the distally based lateral arm flap and the ulnar recurrent fascicutaneous island flap could to be transferred distally but reached only the proximal third of the forearm. In our experience these flaps did not seem to be very reliable. Lengthening of the lateral arm flap pedicle using the lateral triceps artery (branch arising from the profunda brachii artery) allows the lateral arm flap to be transferred beyond the distal third of the forearm. This so-called "extreme" lateral arm flap has advantages and disadvantages which are discussed in this paper. We consider cutaneous or osteocutaneous reconstructions of the forearm to be the best indication for this flap. Our first clinical case is reported.

Accidents, Traffic↗
PubMed1994

[Reverse flow YV pedicle extension: a method of doubling the arc of rotation of a flap under certain conditions].

The authors present a new surgical procedure which allows the transfer of pedicled flaps distally to the origin of their vascular pedicle. They call this procedure the "reverse-flow YV pedicle extension of a flap". The idea is to raise a flap distally on a branch of a Y-like vascular bifurcation. The section of the trunk of the bifurcation turns the Y-into a V-vascular pattern, which allows distal mobilisation of the flap on the remaining branch of the V. The distal range of transposition of the flap can reach twice the length of one bifurcation of the flap. The arterial blood supply is provided by reverse-flow through the attached remaining branch of the V. Venous drainage is ensured as in a distally based pedicled flap. Up until now, the authors have performed six different applications of this procedure: arterial lengthening of a latissimus dorsi flap pedicled on the circumflex scapular artery for coverage of the vertex (a venous anastomosis is required in this case; lengthening of the submental vein in very distal transfers of a submental flap; lengthening of an arteriovenous pedicle: transfer of the anterior interosseous flap which can reach the PIP joint of long digits, transfer of an amputated digit on to the adjacent stump, distal transfer of a medial plantar flap allowing it to reach the tip of the toes, transfer of the lateral arm flap on to the triceps branch of the profunda brachii artery. This flap can reach the metacarpal area of the hand. This procedure seems to very usefully replace microsurgical techniques in many circumstances in which, until now, they would have been necessary. Further applications will be discussed.

Female↗