[Dorsal cutaneous adipofascial flaps of long fingers]. / Les lambeaux cutanés a pédicule adipofascial de la face dorsale des doigts longs.

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.

[Results of emergency repair of wounds of palmar collateral nerves of the fingers]. / Résultats de la réparation en urgence des plaies des nerfs collatéraux palmaires des doigts.

A group of 107 patients with 110 injured digital nerves was studied one year after microsurgical nerve suture. Return of sensibility was tested within the autonomous zones for the nerve. Four tests were used to appreciate the results: pain, Tinel sign, Weber two point discrimination test, the return of the sensibility appreciated by the patient himself. At follow-up, 86 per cent of the patients were found without pain, 75 per cent without Tinel sign, 68 per cent achieved a two point discrimination test of < or = 7 mm, 18 per cent were found with a discrimination test value of 9 mm or more. 93 per cent were satisfied or very satisfied. Of the factors studied, the patient's age at the time of nerve suture was found to be directly related to the return of sensibility as tested by two point discrimination test. Although the return of sensibility following nerve suture in adults is not as good as in children, primary suture of the nerve is worthwhile, a protective sensation is better than an anesthetic digit, and the incidence of painful neuroma is very minimal. The findings in the present study indicate that the nerve suture gives better results that the nerve graft.

[Professional absenteeism and surgery for carpal tunnel syndrome. Results of a prospective series of 233 patients]. / Interruption professionnelle et chirurgie des syndromes du canal carpien. Résultats d'une série prospective de 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.

[Stabilization-interposition arthroplasty in peri-trapezial arthritic lesions. Apropos of a prospective series of 200 cases]. / Les arthroplasties de stabilisation-interposition dans les lésions arthrosiques péri-trapéziennes. A propos d'une série prospective de 200 cas.

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.

[Endoscopic decompression of the median nerve in the carpal tunnel. Apropos of 1,400 cases]. / Décompression endoscopique du nerf médian au canal carpien. A propos de 1 400 cas.

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.

[Anatomy of the lymphatic system of the arm]. / Anatomie du système lymphatique du membre supérieur.

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.

[Solitary carpal osteochondroma. Apropos of a case]. / L'ostéochondrome solitaire du carpe. A propos d'un cas.

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.

[Mucoid cysts of the distal interphalangeal joints of the fingers. Apropos of a prospective series (100 cases)]. / Les kystes mucoïdes des articulations interphalangiennes distales des doigts. A propos d'une série prospective (100 cas).

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.

[The efficacy of naftidrofuryl on unexpected autonomic symptoms following carpal tunnel surgery]. / Efficacité du naftidrofuryl sur les signes neurovégétatifs survenant dans les suites de la chirurgie du canal carpien.

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.