[Surgery of the index finger. "All or nothing" approach].
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Biomedical subjects
Publications and source records attributed to M Merle.
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Transplantation of the second toe to replace a finger has been suggested more recently than has transplantation of the great toe to replace the thumb. The technique is described in detail. There is no plantar skin incision in the foot. The arterial suture is made at the level of the digital artery. Two toes can be transplanted when several fingers are missing. 11 cases have been operated on and the results analysed. In all cases, pinch grip between the thumb and the transplanted finger was made possible.
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Microsurgery has brought important progress in the primary treatment of wounds of the hand. Microsuture of flexor tendons (Kleinert), revascularization by arterial and venous repair and bundle suture of nerves are all proven techniques which favour healing and functional recovery, provided early mobilization is instituted whenever possible.
The foot is an invaluable bank of spare parts available for reconstructing the mutilated hand. The dorsalis pedis flap, the extensor digitorum brevis muscle, and the first and second toes can now be used as free transfers. We believe that partial toe transfers, including either sensitive cutaneous flaps or composite tissue, are also extremely useful in properly selected patients.
Pre- and post-operative radiological appearances of various isolated congenital malformations of the hand are described, as observed in a personal series of 52 cases. Six groups of malformations can be distinguished, and are, in decreasing order of frequency: agenesias, syndactylies, duplications, amniotic bands, arthrogryposis, and macrodactyly.
A rather unusual case of a cartilaginous tumor of the soft tissues, without bone connections, is reported. The tumor was a chondroma developing from the extensor tendon sheath. The general characteristics of non-bony chondromas are described and similar observations reported in the published literature reviewed. Problems raised by differential diagnosis by radiological examination are discussed.
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