[Long-term functional results after upper limb reimplantation: results in 20 cases after a mean follow-up period of 3 1/2 years].
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Biomedical subjects
Publications and source records attributed to V Mitz.
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The authors describe the treatment which they recommend for fractures of the fifth metacarpal. After a brief description of fractures of the proximal end of the diaphysis and of the head of the bone, they study in detail fractures of the neck of the fifth metacarpal. They found that conservative treatment is not very successful but that internal fixation tends to have iatrogenic complications. They recommend a transverse pinning of the bone after reduction by manual traction. Two or three pins are driven from the fifth to the fourth metacarpal through the head and the shaft. This treatment allows early mobilisation.
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A cutting needleholder has been designed for microsurgery. After a little practice, the surgeon will find that the advantages of this instrument outweigh some disadvantages.
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In the presence of peripheral nerve damage, the only acceptable procedure is suture without tension, carried out under excellent conditions of fascicular approximation. In the case of loss of substance, immediate or secondary suture should never be performed. In the experience of "S.O.S. Main" secondary suture has led to the most disastrous results. Nerve graft, as an emergency, is legitimate in the case or reimplantations, in view of the high degree of technical competence of the teams, and the experience acquired. Deffered nerve graft is envisaged at about the end of the second month:--either in the absence of suture,--or in the absence of recovery. When there is any doubt, further examination at the 4 th or 5 th month ensures that treatment is not delayed too long. At all events, examinations must be repeated every two months in order to study nerve regrowth and to determine the need for possible though difficult reoperation if it stops.
Our clinical experience favors the use of long autologous venous micrografts any time excessive tension is noted along the anastomotic line or in case of a short pedicle in a free flap. The technical problems of harvesting and interposition of these long micrografts are presented.
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Defined by severe injuries of several digital structures and by lesions of several axes, complex hand injuries raise numerous problems of management. The activity of the unit "S.O.S. Hand-Reimplantation" of the Boucicaut Hospital petmitted us to determine the various clinical and socio-professional aspects. In the first part of this article, a statistical study permitted us to define the classes, types and prognosis. In the second part, the repair of each digital structure is considered (skin, bone, joint, extensors, flexors, nerves, vessels) in the light of a complex hand injury. The role of the covering skin in the quality of the results seems very important. The long-term results, their socio-professional consequences, thus permit one to draw up a therapeutic management which aims to repair the maximum number of lesions during the first stage of the operation. The interest of microsurgical repairs of the vessels and nerves requires operation of these complex hand injuries as an emergency, which requires appropriate surgical facilities.
Antibiotic therapy for paronychia has seen its day. It is indicated only rarely and justified only when on the day following infection or during the next few days there are signs of regional or systemic spread. The surgical treatment of infections of the hand is not difficult but should be known, if not learned. A paronychia which has been opened but not cured should be reoperated upon rapidly. An "old" paronychia is a major catastrophe: small fistula, great damage. No surgical quarter for evil organisms!
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