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Biomedical subjects

P Voche

Publications and source records attributed to P Voche.

At least 19 recordsLinked to original sources
PubMed1996

Vascular supply of the palmar subcutaneous tissue of fingers.

The arterial system of the palmar subcutaneous fatty tissue of fingers was studied by injecting a coloured silicone polymer into the vessels of 12 fresh human cadaver hands. Arterial vascularisation of these tissues is ensured by small palmar branches arising from the main digital arteries: there were an average of 7 branches on each side varying between 4 and 12 in the specimens studied. Three anatomical patterns could be distinguished: an I-shaped configuration in 64% of cases, a narrow V-shape in 23%, and a Y-shape in 13%. An accompanying venous network was always present and drained into either the superficial or deep venous network. These anatomical findings confirm the vascular reliability of the homodigital subcutaneous flap described by the authors.

Adipose Tissue↗
PubMed1996

[Treatment of cutaneous loss of substance of the dorsal surface of the proximal interphalangeal joints of fingers. A general review].

Dorsal skin defects of proximal interphalangeal joint (PIP) of fingers are a common situation in hand surgery. Skin grafting is contraindicated in the absence of extensor peritendon. The choice of flap depends on the site and surface area of the skin defect and the injuries of adjacent digits. Homodigital flaps, such as Smith's sliding flap, advancement-rotation or advancement-recession flaps and dorsal V-Y advancement flap, are the first choices for small defects. In case of larger dorsal skin defects, flaps must be raised on the dorsal aspect of the hand, such as reverse dorsal metacarpal flaps, distally based dorsal hand flaps and dorsocommisural flaps. Cross-finger flaps are only used when the previous options are not feasible. Descriptions of the dorsal vascular network have led to the loss of indications for venous flaps, with the exception of the Tsai's venous free flap. In case of multidigital dorsal skin defect, flaps, such as radial forearm flap, pediculed groin flap or free lateral arm flap, used for temporary syndactylisation of the fingers.

Finger Injuries↗
PubMed1995

Wartenberg's sign. A new method of surgical correction.

A method of surgical correction is described for Wartenberg's sign, or persistent abduction of the little finger, using a slip of the extensor digitorum communis of the ring finger. The transferred component can be either the central slip, or the ulnar slip extended by the connexus intertendineus to the little finger. This technique maintains the integrity of the extensor mechanism of the little finger, avoiding loss of active extension, which is frequently observed when extensor digiti minimi is used. The donor site is dependable since the extensor digitorum communis tendon of the ring finger is always composed of several slips. This technique should be considered only in cases of isolated persistent abduction of the little finger, when there is no claw deformity.

Adolescent↗
PubMed1995

Bioabsorbable rods and pins for fixation of metacarpophalangeal arthrodesis of the thumb.

We report results on the use of bioabsorbable pins and intramedullary rods made of high-molecular-weight polylactic acid in both experimental and clinical conditions. In the experimental study, bioabsorbable rods were implanted in rabbit femora. Histologic assessment on nondecalcified bone showed that resorption of the material began at 4 months after implantation and gradually fragmented over a period of 3 years. In 12 patients 13 metacarpophalangeal joints of the thumb were arthrodesed by using one bioabsorbable intramedullary rod with one or two oblique pins. All joints fused within 6 to 8 weeks. During that period there was no sign of inflammation, and there were no nonunions. Postoperative magnetic resonance imaging assessment was done in all rabbits and eight patients. This modality is a useful tool in postoperative evaluation of the position and shape of the rod but is not sufficiently sensitive to assess the presence of local inflammation and the rate of resorption of the rods.

Adolescent↗
PubMed1995

[A simple and efficient pin guide].

The authors propose the use of the metallic trocar used for venous catheter introduction as a pin guide and protector. These trocars are available in several internal diameters, allowing the use of 8/10 mm to 15/10 mm Kirschner pins. This technique has the following advantages: easy guiding of the pins and protection of subcutaneous neurovascular structures. The disadvantages are related to overheating and its consequences due to metal-on-metal friction.

Bone Nails↗
PubMed1995

[Pseudarthrosis and delayed union of the distal phalanx of the long fingers. Apropos of 13 cases].

PURPOSE OF THE STUDY: The authors present 13 cases of delayed or non-union of the distal phalanx of the long fingers treated surgically. MATERIAL AND METHODS: The patients were all men aged from 41 years to 60 years. The involved digits were 4 second, 2 long, 5 ring, and 2 little fingers. The operated side was the right side 5 times, the left one 8 times, the dominant one 4 times. Ten cases were due to inadequate treatment of the initial fracture. The three others cases had no clear explanation. Three types of incisions were used: transverse distal, lateral or an extended one combining the two previous. Bone stabilisation was made either, by longitudinal K wires or with a small cancellous screw. In 7 cases, bone grafting was needed. RESULTS: Bone healing was obtained in 9 cases in an average time of 9 weeks. Further procedures included: 2 distal amputations after septic conditions, 2 removals of distal bone fragment and 2 fusions of the distal interphalangeal joint. Overall results evaluated by the patients themselves were fair, including 2 excellent, 6 good (but 2 after distal interphalangeal joint arthrodesis), 2 mild (1 after distal interphalangeal joint arthrodesis), 1 poor and 2 failures. DISCUSSION: The type of skin incision was chosen according to the bone condition; distal in cases of fibrous nonunion when fibrous tissue removal and bone grafting were needed. Neither the type of bone stabilisation (pinning or screwing) nor the donor site of bone grafting influenced the final result. CONCLUSION: The authors would like to stress the importance of an adequate treatment of finger injuries in a emergency situation, considering the difficulties to restore secondarily a satisfactory functional outcome.

Adult↗
PubMed1994

[Injuries of the flexor tendons of the hand].

Diagnosis of clear-cut severing of the two flexor tendons is simple and obvious. This is not true for isolated injury to a single tendon and for partial severing. In this case, careful clinical examination and routine surgical exploration of any wound with regard to the course of the flexor tendon is required. Surgery should aim at the least traumatic repair possible, followed by specialised rehabilitation directed by the surgeon. In the distal region, reinsertion into the bone is required. In other regions, suture consists of a the main suture with a continuous suture of the epitendineum. The region of the digital canal requires rigourous care due to its specific anatomy. The corollary to good surgical repair is rehabilitation, understood and complied with by the patient. Early mobilisation procedures are used predominantly in order to avoid the formation of postsurgical adherences.

Hand Injuries↗
PubMed1994

The homodigital subcutaneous flap for cover of dorsal finger defects.

The authors propose a volar subcutaneous pedicled flap to cover skin defects over the dorsum of the same finger. This flap includes all the subcutaneous (adipofascial) tissues from the reticular dermis to the synovial sheath of the flexor tendons. After elevation of the dermo-epidermal flap, the subcutaneous tissues are raised as a flap pedicled laterally on one of the collateral arteries which constitutes the axis of rotation and transposition. After release of the collateral neurovascular bundle from its connections with the skeleton, the skin and the synovial sheath, the flap can be transposed to the dorsum of the finger and then covered with a split thickness skin graft. The advantages of this technique are: (1) No functional or cosmetic sequelae at the donor site which is closed by the volar dermo-epidermal flap; (2) Homodigital flap. This is particularly helpful in cases of multidigit involvement where cross-finger flaps cannot be performed; (3) Vascular reliability; (4) Preservation of both collateral arteries.

Adult↗
PubMed1994

[The "star": a design principle of antebrachial radial fasciocutaneous flap. Technical note].

In performing a fasciocutaneous radial forearm flap to cover the dorsum of the hand, the authors suggest to draw the flap as an eight-tip star. This technical tip allows to minimize the centripetal skin healing process at the recipient site (currently observed in case of circular or ovoid defect) and to reduce the scared aspect at the donor site, by first closing of the four cardinal tips.

Burns, Chemical↗
PubMed1994

[Microsurgical coverage of proximal amputation of the forearm. Functional value of preservation of the elbow joint].

The authors reported three traumatic cases of below-elbow amputation. The proximal squeleton of the forearm was bare-exposed and the replantation was not done due to the mechanism of the injury. To preserve the function of the elbow joint which the main components were safe, the soft tissue coverage was realized by a musculocutaneous latissimus dorsi free flap in each case. A body-powered forearm prosthesis was adapted for the three patients who were able to return to an adapted job in an average time of 8 months. The importance of the preservation of the elbow joint to improve the function in upper limb amputees is discussed.

Adult↗
PubMed1993

[Arthrodesis of 4 bones of the wrist. Study of 12 follow-up cases].

From November 1988 to December 1990, 15 four-bone fusions (capitalum-lunatum-triquetrum-hamatum) were performed in our department. 3 cases were lost at follow-up, so we here describe 12 cases reviewed for a clinical and radiologic evaluation. Etiologies were as follows: advanced scapholunate dissociation: 5 cases; advanced pseudarthrosis of the scaphoid: 6 cases; ulnar midcarpal instability: 1 case. Follow-up averaged 18.8 months with a range of 6 to 29 months. Pain was significantly lessened: 9 patients had either no pain, pain influenced only by weather, or pain after sustained effort. Results for strength were average. Joint motion was severely restricted, with individual variations among patients. Remaining joint motion was of little use, and some activities of daily living were thus hampered. Pre and postoperative radiologic analysis of the carpus showed that repositioning the proximal row into the distal row of bones was not necessary. In order to obtain a good result, it suffices to stabilize the existing carpal collapse without attempting to restore carpal height. Study of this short series showed the efficacy of this arthrodesis as regards to pain although it significantly decreased the range of motion.

Adult↗
PubMed1993

[Correction of posttraumatic disorders of the distal radio-ulnar joint with the Sauvé-Kapandji surgical procedure].

The Sauve-Kapandji procedure was performed on 21 patients with posttraumatic lesions between May of 1985 and May of 1991; average clinical and radiological follow-up was 3.4 years. Causal mechanisms were as follows: 12 cases were sequelae of fractures of the distal extremity of the radius; 5 cases were sequelae of fractures of the diaphyses of the two forearm bones and/or of the head of the radius; 2 cases of instability of the distal radio-ulnar joint; 2 cases of posttraumatic isolated arthritis of the distal radio-ulnar joint. Subjective evaluation by the patients of the results of surgery was as follows: 8 excellent, 6 good, 2 satisfactory and 5 poor. The most consistent improvement was a gain of mobility in pronation and supination which averaged 87 per cent of that of the healthy contralateral side. Nine patients were free of pain, 6 experienced some pain only during effort, and 6 still suffered constant pain. Grip strength was the factor that changed the most: it averaged 55 per cent of that of the healthy contralateral side. Indications for the Sauve-Kapandji procedure and its results in posttraumatic lesions are discussed. This procedure is compared to other techniques used to correct posttraumatic disorders of the distal radio-ulnar joint.

Adolescent↗
PubMed1993

[Arthrolysis of the wrist, indications and technique].

The authors describe a technique of arthrolysis which can be used on the palmar aspect of the wrist, on the dorsal aspect, or on both capsular and ligamentous complexes. The procedure must not be performed before inflammation and retraction phenomena of capsular and ligamentous complex have completely ceased. The surgical procedure must be followed rigorously but is not especially difficult. Criteria for patient selection are emphasized because proper indication is crucial to ensure satisfactory results.

Adult↗
PubMed1992

Scapho-trapezio-trapezoid arthrodesis in the treatment of Kienböck's disease. A study of 16 cases.

Sixteen scapho-trapezio-trapezoid arthrodeses were performed for Kienböck's disease. In ten cases, a prosthetic replacement of the lunate was inserted at the same time. Clinical results were good with regard to pain and fair with regard to grip strength which was improved by an average of 32%. In contrast, the arc of flexion-extension was 38% less than on the unoperated side. Long-term radiographic assessment showed the efficacy of the procedure in maintaining carpal height. Biomechanical observations and a review of poor results showed the limits of the method and the importance of correct positioning of the scaphoid. We concluded that triscaphe arthrodesis was a useful procedure for the treatment of Kienböck's disease in Decoulx's stage 3.

Adult↗
PubMed1992

[Use of intraosseous resorbable implants. Experimental evaluation and clinical applications in hand surgery].

The authors report about their experience with the use of absorbable intramedullary nails. After an experimental phase comprising mechanical tests and animal experiments in rabbits, the first clinical applications were for 24 cases of metacarpophalangeal arthrodesis of the thumb. For this indication, bone stabilization was achieved by associating an absorbable intramedullary nail and a metallic oblique pin. Evaluation in animals included, on one hand, a magnetic resonance imaging study, and on the other hand a histological study after the staggered sacrifice of the animals. This histological study was performed on non-decalcified bones by inclusion in methyl methacrylate resin. The mechanical results confirmed the appropriate resistance of these materials for use in the digital skeleton. The histological assessment showed that absorption begins around the 4th month by progressive fragmentation of the material and lasts over 3 years. The encouraging clinical experience and some obstacles encountered during its implementation hav led to two modifications: on one hand, a larger nail was used, on the other hand an absorbable oblique pin was developed, thus ensuring a fully absorbable osteosynthesis.

Adult↗
PubMed1991

[Scapho-trapezo-trapezoidal arthrodesis or triscaphe arthrodeses. Study of 36 reviewed cases].

From May 1983 to September 1988, we performed 41 triscaphe arthrodeses, 36 of which underwent clinical and radiologic follow-up examination. The 36 preoperative diagnoses were classified as: Kienböck's disease (16 cases), chronic rotatory subluxation of the scaphoid (static scaphoid-lunate dissociation) (13 cases), degenerative arthritis of the scapho-trapezio-trapezoid joint (4 cases), traumatic lesion of the scapho-trapezio-trapezoid joint (2 cases), 1 case of midcarpal instability with a non-dissociative VISI pattern. Average length of follow-up was 28 months. Analysis of results showed on the whole good improvement on pain and average improvement of strength; range of motion varied greatly with etiology. For example, the range of motion on the fused side in Kienböck's disease averaged 38 per cent of that of the unoperated side, whereas in other conditions it averaged 60 per cent. Radiographic analysis confirmed the efficacy of triscaphe arthrodesis in preserving normal carpal height but revealed radial styloid impingement in 34 per cent of the cases. Use of this procedure should be limited to stage 3 Kienböck's disease and to scaphoid-lunate dissociation without arthritis. Peroperative radiographic study is indispensable to verify appropriate reduction of the scaphoid and to measure the radial-scaphoid angle. Partial radial styloidectomy should be included routinely in the procedure.

Adult↗