Endoscopically assisted proximal radial nerve decompression: surgical technique.

STATE OF THE ART: The proximal radial nerve compression syndrome includes supinator syndrome and proximal radial nerve constrictions. This article presents a new endoscopic assisted radial nerve decompression surgical technique described for the first time by Leclère et al. in 2013. SURGICAL TECHNIQUE: Endoscopic scissor decompression of the proximal radial nerve is always performed under plexus anaesthesia. It includes 8 key steps documented in this article. We review the indications and limitations of the surgical technique. CONCLUSION: Early clinical results after endoscopic assisted decompression of the radial nerve appear excellent. However, they still need to be compared with conventional techniques. Clinical studies are likely to widely develop because of the mini-invasive nature of this new surgical technique.

[Endoscopically assisted decompression of the median nerve in the pronator and Kiloh-Nevin syndrome: Surgical technique]. / Décompression du nerf médian assistée par endoscopie dans le syndrome pronateur et le syndrome de Kiloh-Nevin : technique chirurgicale.

STATE OF THE ART: The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression. MATERIAL AND SURGICAL TECHNIQUE: Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique. RESULTS: Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development. CONCLUSION: Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.

Carpal tunnel syndrome caused by supernumerous lumbrical muscle in hemihyperplasia of the upper extremity.

INTRODUCTION: Hemihyperplasia of the upper extremity is a rare pathology that occurs in 1/86,000 births. Carpal tunnel syndrome may be associated with this disease. CLINICAL PRESENTATION: We describe the case of a 74-year-old male who has hemihyperplasia of both upper extremities since birth. At the age of 73, he started experiencing continuous, progressive and high intensity pain that occurred more frequently at night and was localized in the right hand. It was associated with paresthesia and hypoesthesia predominantly of the thumb, index finger and middle finger. Clinical examination and electrodiagnosis led to diagnosis of carpal tunnel syndrome. RESULTS: The patient underwent surgical carpal tunnel release to treat the disease. The enlarged nerve was compressed by a supernumerous lumbrical muscle, which was resected intraoperatively. After six months of follow-up the patient has normal sensitivity and grip strength in the right hand. CONCLUSION: Hemihyperplasia should be clearly distinguished from other complex pathologies that may also entail CTS. Since significant variation in the anatomy of the hemihyperplasic extremities is the rule rather than the exception, a conventional open approach should be taken to localize and treat the compression.

[Endoscopic decompression of the ulnar nerve in the cubital tunnel syndrome: about 55 patients]. / Décompression endoscopique du nerf ulnaire dans le syndrome cubital au coude: à propos de 55 patients.

INTRODUCTION: Sulcus ulnaris syndrome is the second most common neurocompression syndrome in the upper limb after carpal tunnel syndrome. Its severity can be appreciated by the Dellon Classification. We present our experience and results after endoscopic decompression. PATIENTS AND METHODS: A retrospective chart review of 55 patients operated over a 3-year period was performed. The patients, 37 men and 18 women, had an average age of 54 years (range: 27-82 years) at the time of surgery. The clinical diagnostic was always confirmed by a neurophysiological examination of the nerve conduction. According to the Dellon Classification, 11 patients had mild sulcus ulnaris syndrome, 31 had moderate and 13 had severe. The mean follow-up time was 21 months (range: 6-42 months). RESULTS: The sensibility was normalised in 85% of the patients. Compared to the contralateral non-operated side, the mean grip strength improved from 68 to 94% and the mean pinch grip from 72 to 95%. The rate of nerve luxation did not change (5.5%). According to the modified Bishop rating system, 38 patients (69%) had excellent, 13 patients (23.5%) good and four patients (7.5%) fair results. One haematoma necessitating a revision, a minimal lesion of the ulnar nerve with restitution ad integrum and a hypoesthesia of the elbow, occurred after surgery resulting in a complication rate of 5.5%. Ninety-eight percent of the patients responded that they would undergo the endoscopic procedure again if needed. CONCLUSION: Endoscopic decompression of the ulnar nerve in sulcus ulnaris syndrome is very well appreciated by patients and also provides promising clinical results.

[Historical review and future orientations of the conventional vascular microanastomoses]. / Revue historique et orientations futures aux microsutures vasculaires conventionnelles.

Microvascular surgery has become an important method for reconstructing surgical defects due to trauma, tumors or after burn. The most important factor for successful free flap transfer is a well-executed anastomosis. The time needed to perform the anastomosis and the failure rate are not negligible despite the high level of operator's experience. During the history, many alternatives were tried to help the microsurgeon and to reduce the complications. A Medline literature search was performed to find articles dealing with non-suture methods of microvascular anastomosis. Many historical books were also included. The non-suture techniques can be divided into four groups based on the used mechanism of sutures: double intubation including tubes and stents, intubation-eversion including simple rings, double eversion including staples and double rings, and wall adjustement with adhesives or laser. All these techniques were able to produce a faster and easier microvascular anastomosis. Nevertheless, disadvantages of the suturless techniques include toxicity, high cost, leakage or aneurysm formation. More refinement is needed before their widespread adoption. Thus, laser-assisted microvascular anastomosis using 1,9 µm diode laser appeared to be a safe and reliable help for the microsurgeon and may be further developed in the near future.

[Breast reconstruction with a free DIEP flap complicated by spontaneous rupture of internal mammary artery]. / Reconstruction mammaire en terrain irradié par lambeau libre DIEP compliqué d'une rupture spontanée de l'artère mammaire interne : à propos d'un cas.

Breast reconstruction with a free Deep Inferior Epigastric Perforator Flap (DIEP flap) is now well established and provides excellent aesthetic results. Nevertheless, preoperative radiotherapy can damage the recipient vascular axes. We report a case of a grave and undocumented spontaneous rupture of the internal mammary artery related to the use of irradiated arterial vessels.

[Microsurgical nail reconstruction with free short-pedicle vascularized nail flap: about 13 cases]. / Reconstruction de l'unité unguéale par transferts vascularisés à pédicule court. A propos de 13 transferts de l'appareil pulpo-unguéal.

This study was performed to review our 24-year experience in nail reconstruction with special attention to surgical technique, outcomes and cosmesis. A retrospective chart review of 13 toenail complexes transfers alone over a 24-year period was performed. The patients, nine men and four women, had an average age of 20 years (range, 2 to 38 years) at the time of surgery. Etiologies were trauma in 10 cases and tumor in three cases. The mean follow-up time was 13 years (range, 2 to 23 years). One nail flap necrosis occurred after surgery accounting for a complication rate of 8 %. Regarding nail cosmetic, the mean Foucher score was 15.4 points. Though nail reconstruction has been sometimes associated with complications and low cosmetic improvements, this study showed how microsurgery is able to reduce trauma issues.

[Gynecomastia, its etiologies and its surgical management: a difference between the bilateral and unilateral cases?]. / La gynécomastie, ses étiologies et sa prise en charge chirurgicale: y a-t-il une différence entre les cas bilatéraux et unilatéraux?

Numerous excision and liposuction techniques have been described to correct bilateral male breast enlargement. Yet little attention has been directed towards the rare cases of unilateral gynecomastia which have frequently been suspected to be malignant. The purpose of this study was to investigate the results of surgical gynecomastia management and the roles of different treatment modalities in a large patient cohort with special attention to etiology, treatment and outcome in the cases of unilateral involvement.