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Biomedical subjects

P Bellemère

Publications and source records attributed to P Bellemère.

15 recordsLinked to original sources
PubMed2006

[Dorsal cutaneous adipofascial flaps of long fingers].

We report a series with the adipofascio cutaneous flap of the dorsal aspect of long fingers used with an anterograde or retrograde pedicle. Thirty flaps were performed in 29 patients with a mean age of 43 years, 16 cases in emergency and 13 cases secondary for the treatement of traumatic sequelae. The adipofascial pedicle was retrograde for 22 flaps and anterograde for 8 flaps. The donor site was adjacent of the cutaneous defect in 21 cases or at a distance in 9 cases. Transcient veinous congestion was observed in 2 cases. No necrosis was reported. A second surgery of plasty was performed in 1 case for a cutaneous bulk. The quality of the cutaneous coverage gave any functional discomfort and was evaluated very satisfying. These flaps have an important adaptabily of utilization depending on the localisation and the size of the cutaneous defect as well as the quality of its surrounding skin. The homodigital feature of these flaps avoids the disadvantages of the dorsal hand flaps or the heterodigital flaps. Due to their anastomotic vascularisation, these flaps are reliable and therefore can be recommended for the treatment of dorsal cutaneous defects of long fingers less than 2.5 cm.

Adolescent↗
PubMed2004

Return-to-work interval and surgery for carpal tunnel syndrome. Results of a prospective series of 233 patients.

AIM OF THE STUDY: To evaluate the connection between the type of patient insurance and the time taken to return to work after carpal tunnel surgery. PATIENTS AND METHODS: Two hundred and thirty-three patients in full-time work were operated on for carpal tunnel syndrome between 1 January and 30 June 1998. They were divided into three groups: independent workers (n=87), wage earners in the private sector (n=90) and civil servants (n=56). Four categories were defined: manual workers, non-manual workers, patients with social security insurance and patients with workers compensation. The average return-to-work interval after surgery for each of the groups was evaluated and compared group by group. RESULTS: For independent workers the average time off work is 17 days, for those in the private sector it is 35 days, and for civil servants it is 56 days. Patients with social security insurance were off work for 32 days and those with workers compensation for 49 days. DISCUSSION: The comparison shows significant differences with regard to social security insurance: the return-to-work interval in civil servants is larger than for private sector workers, and this is higher than in independent workers. The difference between patients with workers compensation and those with social security insurance is 17 days and significant. There is a significant difference between manual and non-manual workers in independent and private sector workers. There is no significant difference between the sub-groups in the civil servants. These cross references enable us to work out the influence that social security status has on the return-to-work time following surgery.

Adolescent↗
PubMed2003

[A national campaign for the prevention of hand accidents].

The objective of this article is to propose the launch of a prevention campaign against hand-related accidents. This effort is motivated by: epidemiological studies which, despite their disparate and inhomogeneous character, show that hand and wrist accidents are the primary cause of traumatic lesions. They occur two-third of the time during daily activities. For the work-related accidents, they are also the primary cause of work stoppages as well as permanent invalidities. current legal and regulatory prevention measures have reached their efficacy limits. These can not be applied to errors of individuals by inattention, negligence or a lack of information. Sensibilization efforts in public education, professional training programs or direct to the public are still much too limited in scope and are never included in a global strategy. The objective of the prevention campaign will be to increase public awarenesses as a function of one's milieu (school, workplace, leisure, household) to identify the risks of hand injuries and to provide advice on how to avoid them. In this context, the operationalization of the campaign will pass, at the level of each region, by the coordination of each traditional agencies (public health, local government, corporations), of new partners (insurers, renters or sellers of handiwork and gardening equipment, etc.), as well as FESUM centres.

Accident Prevention↗
PubMed2003

[Eight days of hand emergencies. Report of the audit carried out at the FESUM centers from June 3 to June 9, 2002].

All the FESUM centers in France, Belgium and Switzerland were invited to participate in this prospective audit, during 1 week in June 2002. In these FESUM centers, the patients are operated by senior hand surgeons or trainees graduated with a microsurgical and a hand surgery University degrees. All acute hand disorders, requiring surgery or not, were to be included. For every case, a standardized form was to be filled. This form included 22 fields concerning the specificities of the patient, the circumstances of the accident, the lesions and initial treatment up to exit of the patient out of the Hand Center. Out of the 43 French centers, 38 (90%) participated in this study, but only 30% in the other French speaking countries. A total of 2360 forms were completed and analyzed, representing a mean of 8 forms per day center (6-147). The population was predominantly active men with a mean age of 31. Manual workers represented 41%, scholars 33%. Most of them came to the Hand Center with a non-specilized vehicle (86%). Emergency medical transportation was required in 130 cases (5.8%). A majority of the patients were treated on an outdoor basis. A 1-day admission concerned 29% of the patients, and 4.6% have been admitted on an indoor basis during several days. Work accident represented 28% of all the cases, while the majority was daily living (62%) or sport (15%) accidents. Closed trauma represented 50% of the cases. Amongst open trauma (974 cases), 862 were simple skin lacerations, 156 skin loss, 140 extensor tendon lacerations, 70 flexor tendon lacerations. A preliminary wound exploration had been performed in a non-specialized center in 124 cases (12%). Complete amputation of some part was observed in 33 cases. In 32%, the initial severity of the lesion led to expect some degree of definitive consequences. Some kind of anesthesia was required in 43% of the cases (local in 41%, troncular in 19%, plexical in 28% and general in 9%). A surgical procedure was performed in 45% of the patients. Microsurgery was necessary in 15%, six of which were replantations. The period between presentation to the Hand Center and treatment was less than 1 day in 95% of the cases. Time of treatment was considered to be delayed in 113 cases (5%). Following this audit, it is considered that the FESUM centers make provision for the care of 120,000 cases per year, 54,000 of which needing a surgical procedure. This may be a small part of the total load of emergency hand surgery throughout the country (generally estimated over 1.4 million), but compares quite favorably with other European studies. We believe that improvement relies essentially on a better orientation of the patients whether they need a simple skill or specialist skill treatment. An information leaflet about orientation of hand trauma has been distributed to non-specialized emergency centers. Hand surgery training must be reevaluated inside the universitary system to avoid a dramatic lack of hand surgeons within a few years. A new audit will be presented next year.

Adolescent↗
PubMed2001

[Professional absenteeism and surgery for carpal tunnel syndrome. Results of a prospective series of 233 patients].

AIM: The aim of our work was to evaluate the influence of the type of patient's insurance ant the return to work interval after carpal tunnel release. MATERIAL AND METHODS: An prospective analysis of 233 patients (18-65 years old, full time workers) undergoing a carpal tunnel release between January and June 1998 was conducted to determine the interval between surgery and return to work. For statistical analysis we used the Ms Works and Status software package. The mean return-to-work intervals were determined for the following and compared for three groups. Group 1: independent worker, n = 87; group 2: wage earner, n = 90; group 3: civil servant, n = 56; and 4 others subgroups: manual workers, n = 164; non manual workers, n = 69; patients with social security insurance, n = 191; patients with workers compensation, n = 42. RESULTS: For the patients in group 1 the average return to work was 17 days (11 days for non manual workers, 29 days for manual workers). In group 2, the average was 35 days (21 days for non manual workers, 42 for manual workers). In group 3 the average was 56 days (49 days for non manual workers and 63 days for manual workers). The statistical analysis showed the civil servant took significantly longer to return to work than independent workers or wage earner (p < 0.05). The work related patients took significantly longer than patients covered by social security. The effect of occupational han (manual versus non manual) use was clear in the group 1 and 2, but there was no difference in the group 3. DISCUSSION: Our study of 233 patients demonstrated significant difference between independent workers, wage earners, and civil servants in term of return-to-work intervals. In comparing manual and non manual workers, we found a significant difference in group 1 and 2, but in civil servants group non difference were found. We cannot explain these findings on medical grounds.

Absenteeism↗
PubMed1998

[Traumatic lesions of the deep branch of the radial nerve].

PURPOSE OF THE STUDY: We report a retrospective study of 21 patients treated for an injury of the deep branch of the radial nerve. The aim of this study was to precise the indication and to evaluate the results of nerve surgery and tendon transfer. MATERIAL: 21 patients, mean age 32, with complete divided lesion of the nerve due to open injury were included. 5 cases with fresh discision of the deep branch of the radial nerve were treated in emergency by suture repair. 16 cases were old lesions. 6 of them had initially severe associated lesions involving skin, forearm muscles or radius. In this case, the treatment of the nerve lesion was delayed after the treatment of the associated lesions. 10 were simple lesions of the nerve who were initially misknowned (6 cases) or caused by a surgical procedure at the proximal forearm (4 cases). METHODS: 4 patients had tendon transfers, due to a very old lesion for one of them and a severe muscle involvement for the 3 others. Twelve nerve graft repairs were performed. Their were 8 troncular grafts and 4 fascicular grafts because the lesion was in the posterior forearm at the level of the terminating branches of the nerve. They required a mean length of 5.8 cm and an average of 3 to 4 cables for nerve graft. RESULTS: The mean follow up was 25 months. Results were appreciated on the recovery of 5 functions (supination, fingers extension, thumb abduction, thumb retropulsion, wrist postero-ulnar extension). Primitive nerve repairs had full recovery in all cases. Tendon transfers had good results. The 12 nerve grafts had 2 excellent results, 8 good results, 1 fair and 1 poor result. These 2 last cases required secondary tendon transfers. DISCUSSION: Traumatic lesions of the deep branch of the radial nerve are often misknowned and often iatrogenic. Nerve surgery provides better functional results than tendon transfers. Nerve grafts in delayed nerve repairs are possible even if the lesion is distal. They give excellent or good functional recovery in most cases after a delay of 7 months. Tendon transfers are indicated if nerve surgery fails or in case of large forearm muscle defect, old patient, and when the delay after the injury is superior to 12 months.

Adult↗
PubMed1994

[The Guepar total elbow arthroplasty].

The Guepar total elbow replacement is a low friction, minimally constrained gliding prosthesis. The humeral and ulnar components are of metal with intramedullary stems, which are cemented. There is a sigmoid shaped, high density polyethylene interposition bearing. The authors have used the prosthesis in 33 patients with rheumatoid arthritis, 4 with post-traumatic problems, one with chondrocalcinosis and another with degenerative changes of uncertain aetiology. In the patients with rheumatoid arthritis, one sustained a posterior dislocation and two suffered deep infection. In the remaining 30, the overall results were good at an average review of 32 months. The mean range of movement had increased by 31 degrees and pain was absent in 28 elbows. In the management of rheumatoid arthritis total elbow arthroplasty must be part of an overall plan of treatment. Severe involvement of the wrist and shoulder must be dealt with before elbow replacement is considered.

Adult↗
PubMed1994

[Stabilization-interposition arthroplasty in peri-trapezial arthritic lesions. Apropos of a prospective series of 200 cases].

A group of 200 arthroplasties (180 patients) for basal thumb arthrosis is reported. The used technique is similar to that described by Burton and Pelegrini in 1986. At the last follow up (2 years minimum), 90% patients were without pain, 95% were very satisfied, the grip strength was improved in 70%, and the shortening of the thumb was between 2 and 9 mm (mean 6 m). The mobility of the first metacarpal is improved in only 47%. Complications were limited to two NAD for patients operated of carpal tunnel syndrome in the same time.

Aged↗
PubMed1994

[Endoscopic decompression of the median nerve in the carpal tunnel. Apropos of 1,400 cases].

We report the results of endoscopic carpal tunnel release in 1,400 patients over a two year period (minimum 6-month follow-up). All patients were operated on using a technique derived from that of Chow. Complications were limited to two partial lesions of the superficial palmar arch and one interdigital nerve lesion. The technique is described. Analysis of the results indicates the advantages of this method. Though immediate post-operative comfort was greater and restoration of the grip quicker, the results were roughly similar to those of the classic method in the 6 months following surgery. Sympathetic dysfunction represented only 0.28% of cases. Patients generally returned to work earlier than with the classic technique. This method does not replace the conventional technique for certain indications. The authors emphasize the difficulties involved and recommend that this method be used only by experienced surgeons and aware of intra-operative risks.

Adult↗
PubMed1994

[Anatomy of the lymphatic system of the arm].

The lymphatic system of the upper limb is studied according to its various networks: superficial, deep, axillary lymph nodes and anastomotic system. The most important superficial lymphatic system is described in the upper limb together with its applications for manual lymphatic drainage. The microstructure and function of the lymphatic system are studied. The pathophysiology and manual and microsurgical treatments of lymphoedema are not discussed in this article.

Arm↗
PubMed1994

[Solitary carpal osteochondroma. Apropos of a case].

A bone tumor appeared progressively on the back of the wrist of a 62-year-old woman. Clinical and radiological aspects suggested a chondroma or chondrosarcoma. However, this was a solitary carpal osteochondroma arising from the capitate bone. The authors discuss the various features of this benign tumor.

Bone Neoplasms↗
PubMed1994

[Mucoid cysts of the distal interphalangeal joints of the fingers. Apropos of a prospective series (100 cases)].

100 mucous cysts of distal interphalangeal joint were treated by a radical excision that involved skin, cyst and dorsal capsular structures. The follow up was 2 years minimum, only two recurrence were noted, with other procedure the tate of recurrence is higher (10 to 20%). The proposed procedure is based on two hypothegenesis: skin localisation of mucous jelly, and degeneration of dorsal capsular structure of an arthritic joint.

Adult↗
PubMed1994

[The efficacy of naftidrofuryl on unexpected autonomic symptoms following carpal tunnel surgery].

Symptoms of sympathetic lability occur 30 days after carpal tunnel surgery in about 2.6% cases. A double-blind placebo controlled clinical trial of naftidrofuryl was conducted in 195 patients. It demonstrated that these symptoms occur during the two-week-period after surgery, and that some patients are particularly exposed to an unexpected course (i.e. women and more than 50 years) during the third and fourth weeks after surgery. In this study, patients treated with naftidrofuryl showed a reduction of some symptoms of sympathetic lability, and stabilisation of the unfavourable course observed in patients with placebo; this preventive efficacy of naftidrofuryl could be due to its 5-HT2 receptor blocking action, which is responsible for vasoconstriction and platelet and erythrocytes aggregation. Naftidrofuryl though improves arteriolar haemodynamics, limiting the development of pain and oedema.

Age Factors↗
PubMed1992

[Three rare fractures of the radius associated with an ulnar slipped epiphyses].

Over a period of 7 years, three adolescent boys had an associated diaphyseal fracture of the distal third of the radius with separation of the distal ulnar epiphysis. The fracture involved towards early epiphysiodesis of the growth plate of the distal ulna leading to a shortened ulna without any severe functional disability. The mechanisms of injury and complication are described. The treatment of this associated lesion is classical emergency, but the radiological follow-up must be extended in time because the growth potential of the forearm bones is important even during adolescence. The onset of a growth disturbance requires rapid surgical epiphysiodesis of the radius to prevent the development of deformity.

Adolescent↗