General principles of tendon transfers: The ten commandments.

Transferring a muscle's point of force application by modifying its distal insertion will modify its function. This is the basic principle of tendon transfers. Despite being less popular due to superior primary nerve repair results, hand surgeons must be familiar with them. When used according to the Ten Commandments we propose, they provide good and useful functional recovery. Obviously, it depends on the number of muscles available for transfer. Tendon transfer is useful not only in nerve trunk palsy and brachial plexus lesions but also in upper limb tetraplegia rehabilitation. Tendon transfers are active palliative treatments under voluntary command and can be combined with other palliative procedures (arthrodesis, tenodesis) to improve the functional result. Nevertheless, they are far from ideal, as they re-allocate the remaining forces of the limb but do not create new ones.

Scapula alata: Diagnosis and treatment by nerve surgery and tendon transfers.

Scapula alata, also known as winged scapula, can lead to severe upper limb impairment. The shoulders' function is altered because the scapula, which supports the upper limb, is no longer stable. Typical scapula alata is described for serratus anterior palsy; however, any scapulothoracic muscle impairment may lead to scapular winging, particularly trapezius palsy, which is easy to miss, thus needed to be considered as a differential diagnosis. The diagnosis is difficult and based on various clinical tests and a thorough examination as well as electroneuromyography and MRI. The treatment ranges from conservative treatments for spontaneous recovery, nerve surgery including neurolysis, nerve transfers and nerve grafts for acute cases, to tendon transfers for more chronic cases and when nerve procedures are no longer feasible. Tendon transfers in serratus anterior palsy produce excellent results with a high rate of patient satisfaction and are described with the sternal or clavicular head of the pectoralis major; we describe our preferred technique in this article. Tendon transfers in trapezius palsy are performed with the levator scapulae, rhomboid minor and major muscles. Our preferred method is the Elhassan triple transfer. Scapula alata is a frequent and often misdiagnosed condition. Appropriate management can yield excellent results. Patients should be referred right away to specialized centers for surgery if recovery is not spontaneous.

3D-printed scaffold combined to 2D osteoinductive coatings to repair a critical-size mandibular bone defect.

The reconstruction of large bone defects (12 cm3) remains a challenge for clinicians. We developed a new critical-size mandibular bone defect model on a minipig, close to human clinical issues. We analyzed the bone reconstruction obtained by a 3D-printed scaffold made of clinical-grade polylactic acid (PLA), coated with a polyelectrolyte film delivering an osteogenic bioactive molecule (BMP-2). We compared the results (computed tomography scans, microcomputed tomography scans, histology) to the gold standard solution, bone autograft. We demonstrated that the dose of BMP-2 delivered from the scaffold significantly influenced the amount of regenerated bone and the repair kinetics, with a clear BMP-2 dose-dependence. Bone was homogeneously formed inside the scaffold without ectopic bone formation. The bone repair was as good as for the bone autograft. The BMP-2 doses applied in our study were reduced 20- to 75-fold compared to the commercial collagen sponges used in the current clinical applications, without any adverse effects. Three-dimensional printed PLA scaffolds loaded with reduced doses of BMP-2 may be a safe and simple solution for large bone defects faced in the clinic.

Clinical, functional, and radiological results of the Amandys® interposition arthroplasty in 13 cases of wrist osteoarthritis.

Amandys® pyrocarbon interposition arthroplasty is intended for widespread arthritis of the wrist. The aim of this study was to assess the clinical, functional, and radiological results of this arthroplasty with a minimum follow-up of 12 months. This retrospective single-center study brought together all osteoarthritis indications that can benefit from an Amandys® arthroplasty. Twenty-one implants were used between January 2011 and October 2018. There were seven cases of distal radius malunion, eight SLAC wrists, two SNAC wrists, two cases of Kienböck's disease at Lichtman's stage 4, and two aftermaths of inflammatory arthritis. Twenty-four percent of patients had previously undergone another type of surgery for this wrist arthritis. Six implants were removed, five early for dislocation and one after 6 years for chronic pain. Thirteen patients were reviewed with an average follow-up of 40.7 months (21-90). The average pain level on a visual analog scale was 3.1/10 (0-7). The mean range motion was 36° flexion (10-60) and 33° extension (15-50). The mean grip strength at the last follow-up was 14.8 kg (2-30) (43% of contralateral). The average QuickDASH and PRWE functional scores were 37.9/100 (0-80) and 29.6/100 (0-83.5), respectively. Amandys® interposition arthroplasty is an interesting alternative to total wrist fusion or total wrist prosthesis for widespread arthritis of the wrist. For the implant to be stable, the capsulo-ligamentous systems must be intact.

Free composite medial femoral trochlea osteochondral cutaneous flap for wrist scaphoid and lunate cartilage lesions: Advantages of a skin paddle.

The medial femoral trochlea flap is a chondrocorticoperiosteal flap. It has recently been described in the context of cartilage lesions. It is mainly used for reconstruction in non-union of the scaphoid's proximal pole and Kienböck disease. The medial femoral trochlea flap may be harvested with a skin island flap to monitor its vascularization. The surgical technique has been extensively described for its primary osteochondral form. However, the corticoperiosteal form has not been thoroughly studied and described. Here, we describe and report the early results of three cases of the composite medial femoral trochlea flap, with a skin paddle for postoperative monitoring, being used to reconstruct the injured proximal scaphoid and lunate.

Result of A1 pulley reconstruction after closed rupture of the thumb pulleys during childbirth.

Closed rupture of the thumb flexor tendon pulleys is rare. Although anatomical and biomechanical studies have exposed the roles played by the pulleys in flexor pollicis longus (FPL) function, no standardized surgical management has yet been defined, in contrast to situations where pulley reconstruction is required in the fingers. We describe a case of rupture of the three pulleys in the thumb that probably occurred after violent thumb grasp during childbirth in the absence of any other trauma. We reconstructed the A1 pulley only using an extensor retinaculum graft because no remnants of the native pulleys were present.

Porcine abdominal cutaneous flap model: A simple and reliable method.

The increase of reconstructive microsurgery procedures leads to the development of various technologies. Before being validated in human clinical studies, these technologies and devices need to be validated on animal models. We present a simple, reliable and reproducible model of a cutaneous flap in pigs. This flap is pedicled on the superficial inferior epigastric pedicle (SIEP). The surgical technique is described. This flap can be buried and, if necessary, harvested on both sides. It did not alter the abdominal wall, and so it has allowed painless long-term follow-up of the animals. To our knowledge, this technique has never been reported in pigs.

Long-term outcomes of proximal row carpectomy: A series of 62 cases.

The aim of this study was to determine and analyze the functional and radiographic outcomes after proximal row carpectomy (PRC). We hypothesized that this surgery could restore wrist mobility and function in case of radiocarpal osteoarthritis or severe carpal trauma. Sixty-two patients who had undergone PRC were included in this study: 44 patients with wrist osteoarthritis (11 SNAC, 24 SLAC, 3 Kienböck's disease, 6 other) and 18 patients with severe carpal trauma. Each patient underwent clinical (pain, range of motion, grip strength, functional scores) and radiographic evaluations. At the latest evaluation after a mean of 11.8 years, 15 patients (24.2%) required revision total wrist arthrodesis surgery in a median of 22 months (range, 6-179) because of disabling pain and lack of strength. The failure was statistically correlated with being young and a manual laborer. The range of motion and strength of the operated wrist were 61.5% and 70%, respectively, compared to the contralateral side. PRC remains a reliable procedure for treating wrist arthritis and severe carpal trauma. However, manual activity and being under 50years of age can lead to an early salvage procedure such as total arthrodesis of the wrist. In this subset of the population, another alternative must be considered.

Upper limb nerve transfers: A review.

While upper limb nerve transfers were first described and performed several years ago, they have seen expanded use in the past 20 years. Initially indicated for surgical repair of brachial plexus injuries with nerve root avulsion, the indications have been extended to post-ganglionic lesions because of the excellent results of certain intraplexus nerve transfers. The traditional nerve repair techniques - primary suture and nerve grafting - form the basis of nerve surgery. Although nerve transfer does not replace them, they are a useful supplement as they provide a targeted approach to reinnervation and recovery of key functions of the upper limb. The goal of this review is to provide an overview of the various possible transfers by the function being restored and the quality of the outcomes.

Recovery of rock climbing performance after surgical reconstruction of finger pulleys.

UNLABELLED: This study evaluated recovery of sport performance and correction of bowstringing after surgical reconstruction of closed finger pulley rupture in high-level rock climbers. A total of 38 patients treated with an extensor retinaculum graft were assessed. The mean follow-up time was 85 months, and 30 patients returned to their previous climbing level. The mean total active motion score was 96% of the opposite side. All patients had an excellent Buck-Gramcko score. There was no significant difference in grip strength and tip pinch strength in the crimp position between the injured side and the opposite side. A total of 31 patients were examined with ultrasonography. In 18, flexor bowstringing effects had returned to near-normal values. There was an association between rock climbing level recovery and the flexor bowstringing correction (odds ratio, 6.9; 95% confidence interval, 1.1-42.8). If flexor bowstringing was corrected, patients were more likely to regain their preinjury sport performance. The ultrasonography measurement was a useful tool for predicting functional recovery. LEVEL OF EVIDENCE: 4.

[Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg]. / Un cas de "jambe-banque" pour le sauvetage d'un membre inférieur.

We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations.

Personality correlates of risk perception.

The aim of the present study was to systematically examine the variations of the effects of (1) transitional anxiety states and enduring anxiety dispositions, and (2) worldviews (hierarchic, egalitarian, individualist, and fatalist), as a function of the type of hazard considered. Ten risk factors were identified. Transitional anxiety contributed significantly to the prediction of four of these risk factors. The more anxious the respondents, the higher were their scores for the Common Individual Hazards, Pollutants, and Outdoor Activities factors, and the lower were their scores for the Public Transportation and Energy Production factor. Enduring anxiety contributed significantly to the prediction of the Psychotropic Drugs factor. The more anxious the respondents, the lower were their scores. The four worldview factors contributed significantly to the prediction of three of these risk factors. The more fatalistic the respondents, the lower were their scores for the Pollutants factor, and the higher were their scores for the Public Transportation and Energy Production factor; the more egalitarian the respondents, the higher were their scores for the Pollutants factor; the more hierarchic the respondents, the lower were their scores for the Public Transportation and Energy Production factor; and the more individualistic the respondents, the higher were their scores for the Pollutants and Deviance, Sex, and Addiction factors.

Reductive degradation of carbaryl in water by zero-valent iron.

Reduction of carbaryl solution by zero-valent iron powder (ZVIP) was studied in a rotator batch system (70 rpm) in order to evaluate the utility of this reaction in remediation of carbamate contaminated water. Degradation with different amount of ZVIP: 0.01, 0.02, 0.03, 0.04 g/ml at pH 6.6 and at ambient temperature was investigated. The results show that the process exhibits a degradation rate appearing to be directly proportional to the surface contact area of ZVIP (325-mesh) with the carbaryl molecules. Three analytical techniques were used to monitor carbaryl degradation: (1) A UV-Vis diode array spectrophotometer was used to record all spectra. (2) A high performance liquid chromatography was used to separate by-products and examine the evolution of breakdown products. (3) A home-built spectrophosphorimeter that uses the solid surface room temperature phosphorescence (SSRTP) was employed to observe selectively the decline of the carbaryl concentration at different amount of ZVIP on Whatman no. 1 filter paper. Results show that the reducing degradation of carbaryl with ZVIP as the source of electrons is effective with a half-life close to several minutes.

Use of diffuse reflectance spectrometry in spot test reactions for quantitative determination of cations in water.

Diffuse reflectance spectroscopy can be successfully used for the quantitative determination of small amounts of pollutants like metals. The remission function was found to be linearly proportional to the concentration, when we applied the Kubelka-Munk equation. The color reactions of Cu(II), Co(II), and Ni(II) with dithiooxamide, were realised on filter paper. Reaction between Fe(III) and ammonium thiocyanate was realized on filter paper and gelatine matrix. All measurements were accomplished with a laboratory-constructed reflectometer. We have obtained a calibration curve by plotting the optical density of reflectance A(R) vs log of the mol l(-1) concentration. Limits of detection at the 10(-4) M level were estimated for all the compounds. Linear dynamic range extend over one order of magnitude and shows the potential of device for the quantitative analysis of environmental pollutants.

Room temperature phosphorescence analyses of polycyclic aromatic hydrocarbons using an imaging sensing system combined with a bifurcated optical fiber and a cooled charge coupled device detector.

This paper presents a development of a solid support RT phosphorescence procedure for the determination of polycyclic aromatic hydrocarbons, based on the use of a Xenon flash lamp as the excitation source, a fiber optic sensor as a guide of light, an imaging spectrograph and a cooled two dimensional charge coupled device as the detector. Non fluorescent Whatman N degrees 1 filter paper was used as the solid substrate and, thallium nitrate and sodium iodide were used to enhance room temperature phosphorescence of pyrene, benzo (a) anthracene, naphtalene, phenanthrene, dibenzothiophene, fluorene, coronene and fluoranthene. Analytical curves of eight phosphors give linear dynamic ranges from one and a half to two decades and limits of detection of femtomolar to picomolar/spot were reported. Quantitative analyses in mixtures were also carried out using the internal standard method. Results led to a 10% better accuracy for determinations of pyrene and benzo (a) anthracene.

Rapid treatment of water contamined with atrazine and parathion with zero-valent iron.

The utility of fine-grained iron metal in the remediation of water contamined with Atrazine and Parathion was investigated. Batch procedures under water treatment conditions (ambient temperature and pH of approximately 7) indicated that these pesticides degrade rapidly in the presence of iron powder (40-60 mesh, 40 g/l). The decline in the concentration of pesticide was monitored by HPLC. Experiments with unbuffered solutions showed a steady increase in pH values during the reactions. Therefore, experiments were run in buffered solutions. Different buffered solutions resulted in different degradation rates indicating that the buffer plays an important role in enhancing the degradation process. Tests were also performed on an industrial effluent solution containing a variety of pesticides. Although the products of degradation were not characterized, our HPLC results indicated the disappearance of all the parent pollutants.

Molecular characterization of femA from Staphylococcus hominis and Staphylococcus saprophyticus, and femA-based discrimination of staphylococcal species.

The femA gene encodes a protein precursor which plays a role in peptidoglycan biosynthesis in Staphylococcus aureus and is also considered as a factor influencing the level of methicillin resistance. A femA homologous gene was recently characterized in S. epidermidis, entailing the possibility of femA phylogenetic conservation in staphylococcal species. Accordingly, we assessed the presence of femA homologous genes in S. hominis and S. saprophyticus. Strategy for identification relied upon alignment of S. aureus and D. epidermidis femA sequences and upon identification of potentially conserved regions. Amplifications of portions of the femA genes were performed under permissive annealing conditions, by using several sets of primers designed to match the consensus regions. DNA sequencing of overlapping PCR fragments led to the characterization of the entire femA genes of S. hominis and S. saprophyticus, and provided more precise information on the femA start codon for all five species. The genomic organization of all these femA genes appeared highly conserved, with alternance of homologous and variable regions. On this basis, a consensus sequence of the femA gene was defined and interspecies variations were exploited to design strategies for staphylococci species-specific identification, including multiplex PCR amplification and a reverse hybridization assay.

Quantitative measurements of ammonium, hydrogenophosphate and Cu(II) by diffuse reflectance spectrometry.

Diffuse reflectance spectrometry is shown to be useful for the quantitative determination of small amounts of pollutants. The relation between sample concentration and reflectance is described by the Kubelka-Munk equation. The experiments were performed with a laboratory constructed diode array spectrophotometer. We can obtain the quantitative reflectance values of different precipitates like ammonium with Nessler's reagent, hydrogenophosphate with silver nitrate and a complex such as Cu(II) with dithiooxamide 'rubeanic acid' by forming a spot colour on filter paper. We have obtained for each reagent a calibration curve by plotting the relative intensity of reflectance versus the log of the mol (dm(3))(-1) concentration. The linearity was obtained for Cu(II) from 8x10(-4) to 2.5x10(-2) mol l(-1) with r(2)=0.9838 and from 10(-3) to 10(-1) mol l(-1) for polyphosphate with r(2)=0.9975 and from 5x10(-4) to 5x10(-2) mol l(-1) for ammonium with r(2)=0.9889. We can consider that for a direct measurement of the intensity of reflectance, it is possible to perform quantitative spot-test analysis.

Rapid and specific molecular identification of methicillin-resistant Staphylococcus aureus in endotracheal aspirates from mechanically ventilated patients.

Multiplex amplification of femA and mecA genetic determinants allowed an early and rapid identification of methicillin-resistant Staphylococcus aureus (MRSA) in endotracheal aspirates of mechanically ventilated patients. femA and/or mecA amplification and bacteriological results were concordant in 57 of 60 samples. In all three discrepant cases, complementary bacteriological tests confirmed the presence of MRSA first identified by molecular analysis. These results underline the value and rapidity of this molecular diagnosis for MRSA infection and control surveillance in intensive care units. Rapid MRSA detection is expected to have a significant clinical impact not only on patient outcome but also on the costs for isolation and treatment.