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Biomedical subjects

J C Guimberteau

Publications and source records attributed to J C Guimberteau.

At least 19 recordsLinked to original sources
PubMed2005

[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. Initially, the tendon sheath closure was advised after tendons repair. This sheath recovery had to have an effect on tendons nutrition by establishing the synovial cavity continuity and particularly to protect the tendons from adhesions formation. The closure of the digital tube was rapidly shown to be unnecessary creating an obstacle to the tendons movements without any effect on tendons healing. In primary tendon management, the tendon repair is associated with an increase of the tendon diameter. An incongruence appears with the surrounding digital tube with gliding resistance complicating the tendon injury recovery. In secondary tendon injury management, the flexor digital tube is subject to healing and inflammatory process. This situation with the absence of the flexor tendon generates a retraction with a collapse of the digital tunnel over the injured area. This incongruence between the repaired flexor tendons and the narrowed digital tube required a release of the retracted zone to restore an adequate volume. The only way reported is the "Venting" of a part or the total length of the pulley. This procedure even if it resolves the tendon gliding resistance, is still unacceptable. Indeed it destroys an important anatomical structure of the flexor tendon dynamic system. The flexor pulley Omega plasty "Omega" consists in releasing the lateral palmar attachment of the pulley enhancing its internal volume and increasing the flexor tendon gliding area. The digital tube is composed by the succession of five annular and three cruciform pulleys. The cruciform pulleys are thin and flexible. They retract during the digital flexion assuring the continuity of the digital tube, while the annular pulleys are thicker and fill a biomechanical function. There are two types of annular pulleys: the joint pulleys as A1, A3 and A5; they are attached to the palmar plates of the MP, PIP and DIP joints respectively. During the digital movement, they retract approximately 50% of their length. The osseous pulleys as A2 and A4 are fixed over the lateral and palmar borders of the first and the second phalanx respectively. It is on these pulleys that the Omega plasty is practised. The operative procedure is simple. It consists on a periosteal dissection over the one lateral border of the phalanx. The liberation is undergone palmarly releasing the lateral attachment of the pulley. It respects the anatomical continuity of the pulley and its mechanical properties. Indeed, the continuity of the pulley is fully respected with the periosteal flap of the digital tube floor maintaining sufficient attachment to the pulley to resist to the flexor tendon forces. The level of the flexor tendon injury and the digit position during the initial trauma will determine the level of tendon resistance and where the pulley plasty must be made. If the flexor zone II injury occurred with the digit in an extension position, the tendon conflict appears with the A2 pulley, while it arises with the A4 pulley if the digit was in flexed position. The Omega plasty creates the ideal conditions for an optimal flexor tendon movement recovery. It is a simple and a reproducible procedure. It doesn't distort the mechanical properties of the pulley and the digital tube. We used this pulley Omega plasty fifteen times in twelve patients. In 60% of the cases, the injury concerned the dominant hand, and in 67% of the cases, it was a work accident. In eight of our cases, the omega plasty was done in emergency at the same time of flexor tendon repair, while in the other seven cases, the pulley Omega plasty accompanied the late flexor tendon repair forgotten during the initial trauma management. In ten cases, the plasty concerned the A4 annular pulleys, while in the other five cases, it concerns the A2 annular pulleys. Four cases necessitate a secondary tenolysis three months after the tendon repair. Two patients moved out and cannot be included in our results. On the thirteen-remainder cases, nine retrieved a full digital flexion particularly those who underwent digital tenolysis, while the other four cases retrieved a satisfying digital function in spite of the partial DIP flexion. In our hand, the pulley Omega plasty "Omega" becomes almost a systematic procedure in conjunction with the flexor tendon repair. It offers the ideal conditions for a tendon healing and a physiological flexor tendons motion recovery.

Adult↗
PubMed2005

[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. For decades, scientists thought that the skin was simply an elastic structure with loose connective tissue and a more or less virtual space. However, in biomechanical terms, this explanation is very vague. These old concepts developed more than 50 years ago have evolved thanks to the impact of research at the microscopic level, and the global, mesospheric concept has been abandoned. And yet, surgical dissection in vivo demonstrates that there are only tissue connections, simply a histological continuum without any clear separation between skin and hypodermis, the vessels, the aponeurosis and the muscles. In fact, visible everywhere are structures, which ensure a gliding movement between the aponeurosis, the fat structures and the dermis. As they studied this system of gliding between the various organs, in particular at the level of the tendons, the authors noted the existence of a type of system composed of cables and veil-like structures that they term the Multimicrovacuolar Collagen Dynamic Absorption System (MCDAS). This system looks totally chaotic in organization and seems to function in a manner far removed from traditional mechanical structures. The functional unity of this sliding system is dependent upon a polyhedral three-dimensional crisscrossing in space of the microvacuoles, whose collagen envelope is type 1 or type 4 and whose content is made up of proteoglycoaminoglycans. The dynamic of this multimicrovacuolar system allows all of the subtle movements that occur within the body, thanks to its pre-stressed nature and the molecular fusion-scission-dilacerations that it is capable of. In this way, the system is mobile, can move quickly and interdependently, and is able to adapt is plasticity. This notion of microvacuoles is a fascinating one because it provides an explanation for the system's space-filling ability. The matter is composed of elements. However, although they seem to be arranged in a haphazard manner, this is not the case. In fact, they occupy space in an optimal manner. If we accept this notion of microvacuoles, then it becomes possible to explain certain pathologies occurring with age, such as edema, obesity, aging and inflammation. This sliding system is to be found everywhere in the body and would seem to be the basic network of tissue organization. For this reason, it should be thought of in global terms. Since it constitutes the inseparable link and occurs in all living structures and at many levels, could it be that it the basic architectural design of Life?

Adaptation, Physiological↗
PubMed2002

[Reconstructive surgery using composite tissue allografts: perspectives from the first clinical cases].

Tissue allotransplantation is defined by the transfer of tissues harvested from a cadaveric donor (in a brain dead condition) and revascularized to a recipient subject. This is based on the mastery of microsurgical techniques and on the induction of a therapeutic immunosuppression for the recipient. The first allografts (flexor tendon systems, knees and femoral diaphysis, hands, nerves, larynx) opened the field of composite tissue allotransplantation (C.T.A.) in reconstructive surgery. Immunosuppressive agents are now efficient enough to prevent the rejection of the allografts. The first patients operated on did not suffer from major or irreversible complications, but some potential side-effects of the immunosuppression remain an obstacle to the development of allografts in reconstructive surgery. The early functional results of the allografts are encouraging but their long term evolution remains uncertain. Some immunological (the chronic rejection) or psychological (the refusal of the graft and of its constraints) phenomenon might curtail the functional, aesthetic and psychological result. Currently considered as an extreme solution to exceptional indications, C.T.A. represents a tremendous hope for the future of reconstructive surgery.

Hand Transplantation↗
PubMed1994

[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. But their main indication, as it represents a basic difference with other retrograde flaps, is the possibility of an island transplant of several superficial flexors complete with sheats, for the reconstruction of the fingers' flexing system in a single surgical act. This is all the more interesting as it is still technically possible to combine it with a cutaneous flap, so that the tendinous and cutaneous problems can be solved simultaneously. This technique permits reconstruction of the fingers' flexor system based on another concept, i.e. by using a vascularized tendinous transplant, and under different conditions since a single surgical act is required, thus saving long periods of sick leave, with functional results which compare with those of traditional techniques.

Carpal Bones↗
PubMed1993

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.

Adult↗
PubMed1990

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. All of our patients had previously had at least two operations, one of which was conventional non-vascularized bone-grafting. In all eight patients, primary osseous union occurred in an average of 4.6 months; all were able to resume their previous occupational or athletic activities.

Adult↗
PubMed1988

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.

Adolescent↗
PubMed1983

[Technical aspects of reconstruction of the mandibular region using composite flaps of the latissimus dorsi].

Anatomical data from 20 laboratory dissections are employed to describe a composite flap associating skin, the latissimus dorsi muscle, and ribs, important anastomoses existing between the intercostal and inferior scapula vascular systems. Two cases were treated by single-stage extensive reconstruction of the mandibular region employing this osteomusculocutaneous flap of the latissimus dorsi.

Adult↗
PubMed1979

[Renovascular hypertension in infancy treated by aortorenal by-pass (author's transl)].

The writers record a severe case of renovascular hypertension resulting from fibromuscular dysplasia which appeared in the only main left renal artery. The first clinical symptoms were noticed at five months. The failure of medical treatment led to exploratory surgery at seven months with renal revascularisation by an aortorenal by-pass using a hypogastric arterial autograft. The writers stress the scarcity of hypertension symptoms among infants of less than one year and conclude the impossibility of prognosis in spite of an apparent cure after six months.

Cineangiography↗