Experience of a national campaign for hand trauma prevention in France.

INTRODUCTION: In France, hand injuries are the number one cause of all accidents referred to our hospital casualty departments. Their human and economic consequences are very serious. Two thirds of these accidents arise during everyday living activities and a third of them happen at work. The specific prevention of hand injuries in each of these domains has not been sufficiently developed. The authors present the national prevention campaign recently set up by the FESUM. MATERIALS AND METHODS: The campaign took place in the form of events held in different towns in France. Each event, lasting from a minimum of 2 days to 10 days maximum, included press conferences, prevention workshops specific to hand injuries, theatrical animation for youngsters, conferences for the general public, meetings in industrial or training college environments, photography and video exhibitions, and the publication of pamphlets and posters. These manifestations were carried out in partnership with the association APAVC and the voluntary involvement of surgeons from the FESUM hand centres in each town visited. RESULTS: Over a period of 2 years, 22 large or medium-sized towns were able to hold these campaign events. By this means, thousands of people - adults, schoolchildren or young, professional apprentices - were made aware of hand injuries and how to prevent them. We were able to reinforce the broadcasting of simple prevention messages launched by the campaign, particularly with regard to wearing gloves for all manual activities, with the help of heavy local, regional and national media coverage. CONCLUSION: This campaign was the first widespread action of its kind, aimed specifically at the prevention of hand injuries. Furthermore, it was a way of strengthening the credibility of the FESUM hand emergency centres with the health authorities and to promote the services available to patients.

[Surgeons return to the science of living matter]. / Le retour des chirurgiens dans les sciences du vivant.

The progress in digital and surgical technology has enhanced the exploration and knowledge of the living matter that constitutes our corporal form. Hence, endoscopic intratissular observation of living matter during surgical interventions reveals the structuring elements that are difficult to identify with a cadaver, or tissue sample, using histological and anatomopathological methods. Once the endoscope equipped with a camera has been placed in the heart of the living matter of a patient, one's perception changes and reality wavers. With the help of endoscopic intratissular techniques, surgeons can now explore the world of living human matter. Such observations should be interpreted in collaboration with other scientific specialisations, but they are a fundamental support because they provide a precise vision of the reality of living tissue. This is a new adventure, not only for surgeons but also for the further knowledge of living matter.

[The multifibrillar network of the tendon sliding system]. / Les tendons et le système de glissement multifibrillaire.

After carrying out 215 in vivo dissections, 65 of which were video-recorded, the authors propose that the current representation of the notion of the tendon sliding is incorrect. It is suggested that tendon sliding is explained by the existence of a mechanical adaptable multimicrovacuolar and fibrillar tissue. This tissue enables complete sliding without any dynamic influence on the surrounding tissues. The new theory is based on a polyhedric fibrillar framework, apparently chaotic and complex, subtending the microvacuolar gel, a concept that is to be found everywhere in the human body.

[Towards a structuring fibrillar ontology]. / Vers une ontologie fibrillaire structurante.

Over previous decades and centuries, the difficulty encountered in the manner in which the tissue of our bodies is organised, and structured, is clearly explained by the impossibility of exploring it in detail. Since the creation of the microscope, the perception of the basic unity, which is the cell, has been essential in understanding the functioning of reproduction and of transmission, but has not been able to explain the notion of form; since the cells are not everywhere and are not distributed in an apparently balanced manner. The problems that remain are those of form and volume and also of connection. The concept of multifibrillar architecture, shaping the interfibrillar microvolumes in space, represents a solution to all these questions. The architectural structures revealed, made up of fibres, fibrils and microfibrils, from the mesoscopic to the microscopic level, provide the concept of a living form with structural rationalism that permits the association of psychochemical molecular biodynamics and quantum physics: the form can thus be described and interpreted, and a true structural ontology is elaborated from a basic functional unity, which is the microvacuole, the intra and interfibrillar volume of the fractal organisation, and the chaotic distribution. Naturally, new, less linear, less conclusive, and less specific concepts will be implied by this ontology, leading one to believe that the emergence of life takes place under submission to forces that the original form will have imposed and oriented the adaptive finality.

[Simple and composite ulnar island bone transfers in hand reconstructive surgery]. / Les transferts cubitaux osseux simples et composites en chirurgie reconstructrice de la main.

Over several years, the author has devised different techniques for difficult bony reconstruction in hand surgery. It is based on compound island transfers of ulnar origin, harvested from the forearm's lower third with reverses flow vascularization. Because of the variety of arterial ramifications, these transplants can consist, either of a simple bone ulnar fragment or when associated, of compound cutaneous-osseous, or even cutaneous-tendineous-osseous transplants. These transplants based on a clinical experience of 49 cases can be used by retrograde rotation for a variety of indications such a recalcitrant nonunion of the scaphoid bone, Kienböck disease, osteochondroma with fracture, or severe post-traumatic sequellae. These procedures performed in one operating time permit reconstruction by using vascularized bone and offer large potential solutions improving bone healing.

[The surgical innovation: From the legal framework through the veritable ethics innovation - Technical aspects and practical applications]. / L'innovation chirurgicale : du cadre légal à une véritable éthique de l'innovation. Aspects théoriques et applications pratiques.

Grace to the creativity of surgeons and the introduction of new technologies, second half of the XXth century opened the era of innovations and decisive progress. At the same time, however, is born the feeling of distrust and claiming which has come with the graving and threatening juridiciarisation. The evolution of complex structures of our society joined the ingenuity researchers unlimited makes formal law and the legal framework constantly to adapt oneself to circumstances. In the field of surgery, it's necessary to make work in integrity the innovation and protection at the patient's and their dignity. The legal framework that governs today innovation in surgery must still to go further and will precise. Dignity, compelling paradigm for all those who seek to better understand and better protect human starred as impassable limit any search and any experimentation. To make this chapter more alive, we have supplemented it and illustrated by the testimony some of the most fruitful French last years innovative in order to enrich our thinking of the fruit of their large and brilliant experience.

[Happy who as Ulysse had a nice idea or tale of the brilliant inventor surgeon (BIS) in the Maze]. / Heureux qui comme Ulysse avait une belle idée ou récit du génial inventeur chirurgien (GIC) dans le Dédale.

Through their personal experience, the authors want to relate the problems a surgeon has to face to make an idea accepted, either on the intellectual or the technical or the material point of view. A surgeon's everyday life, his university cursus and his psychological profile does not prepare him to a very different world, the world of administration, of files, of categories, of laws, of initials, of acronyms. Yes, the surgeon has to deal with this universe if he wants to develop his new concept. The authors relate the great efforts, which are similar sometimes to mythological works, to achieve their aim with a little humour just to survive.

The role and mechanical behavior of the connective tissue in tendon sliding.

After carrying out 215 in-vivo dissections, 65 of which were video-recorded, the authors propose that the current representation of the notion of the tendon sliding is incorrect. It is suggested that tendon sliding is explained by the existence of a mechanical adaptable multimicrovacuolar and fibrillar tissue. This tissue enables complete sliding without any dynamic influence on the surrounding tissues. The new theory is based on a polyhedric fibrillar framework, apparently chaotic and complex, subtending the microvacuolar gel, a concept that is to be found everywhere in the human body.

The microvacuolar system: how connective tissue sliding works.

The term 'fascia' has been applied to a large number of very different tissues within the hand. These range from aligned ligamentous formations such as the longitudinal bands of the palmar fascia or Grayson's and Cleland's ligaments, to the loose packing tissues that surround all of the moving structures within the hand. In other parts of the body the terms 'superficial' and 'deep fascia' are often used but these have little application in the hand and fingers. Fascia can be divided into tissues that restrain motion, act as anchors for the skin, or provide lubrication and gliding. Whereas the deep fascia is preserved and easily characterized in anatomical dissection, the remaining fascial tissue is poorly described. Understanding its structure and dynamic anatomy may help improve outcomes after hand injury and disease. This review describes the sliding tissue of the hand or the 'microvacuolar system' and demonstrates how movement of tissues can occur with minimal distortion of the overlying skin while maintaining tissue continuity.

[New views about the skin]. / Faire peau neuve.

As the follow up article to "Introduction to the knowledge of subcutaneous sliding system in humans" published in the "Annales de chirurgie plastique" we further investigate the architecture of the skin and comment on the subcutaneous multifibrillar and microvacuolar arrangements that provide form, mobility, adaptability and resistance to force of gravity. The study aimed to highlight the direct link between the skin and subcutaneous environment in dynamic living tissue. Through high resolution endoscopic observations made during live surgery it is revealed how microvacuoles and microspaces can provide dynamic structure and form during movement between the epidermis, dermis and hypodermis. The study reveals intriguing morphodynamics which are necessary to maintain mobility and continuity to neighboring tissues. The polyhedric design of the skin surface directly relates to multifibrillar pillars beneath the skin which dictate their patterning and movement. The concept of tissue continuity is realised by the chaotic and fractal organisation of multifibrils interlaced with cellular components which characteristics alter depending on the state of hydration. Understanding the integral arrangement that provides continuity of all the structures below the skin provides an appreciation to how skin behaves in relation to movement of the rest of the body.

The Gigogne flap: an original technique for an optimal pulp reconstruction.

The reconstruction of digital pulp defects is still a challenge in hand surgery. Several reconstructive techniques are available, but in some cases, their advancement capacities are not sufficient for the flap to cover the whole defect. The Gigogne flap is a new, very simple and safe technique. It consists of harvesting two cutaneous flaps successively on the same neurovascular digital palmar bundle. The first plasty may be chosen among the well-known flaps usually applied in pulp reconstruction. The second plasty, the Gigogne flap, is an advancement VY plasty done on the main cutaneous paddle of the first proximal flap. We performed 15 Gigogne flaps in 13 patients, who suffered zone II and III digital pulp amputations. The Gigogne flap increased the advancement capacity of the proximal flap as well as restoring the physiological pulp fatty pad, thus reconstructing a functional and aesthetic fingertip.

Temporary ectopic digital implantation: a clinical series of eight digits.

This paper reports our experience with temporary ectopic digital implantation. Four patients suffered 12 digital amputations with large defect over the proximal stumps. Only 8 digits were suitable for microsurgical salvage but the local conditions made direct replantation impossible. In our first patient, the two digits were ectopically implanted onto the foot, while in the second patient the four amputated digits were implanted onto the opposite forearm. After stump reconstruction, the digits were microsurgically transferred to the hand, restoring a functional pinch. One digit suffered a venous congestion and necrosis in the ectopic site caused by a haematoma and another experienced a no-reflow phenomenon. In conclusion, temporary ectopic implantation remains a procedure that can be used to salvage amputated digits.