Cartilage graft from rib to treat trapeziometacarpal arthritis.

Trapeziectomy has been considered as the gold standard for treating trapeziometacarpal arthritis. But trapezial space collapse is responsible for thumb strength decrease and intracarpal deformities (with or without tendon interposition). Partial trapeziectomy with interposition of a chondrocostal autograft combines the advantages of trapeziectomy and a biological spacer without the disadvantages of arthroplasty. Partial trapeziectomy is performed by a dorsal approach, under regional anaesthesia. The graft is harvested by a direct approach of the 9th rib during a short bout of general anaesthesia and inserted in the trapeziectomy space. A thumb spica cast is used for 3-6 weeks. In our experience, long-term outcomes and radiological evolution of the graft are good, similar to that of other procedures reported in the literature, except for strength, which is better in this scenario. With more than 5 years of follow-up, the graft is viable, the length of the thumb is maintained, and any areas of graft metaplasia are localized. The result is stable over time and any donor site morbidity is anecdotal. The interposition of a biological material is feasible and produces a stable and strong thumb.

Functional assessment and quality of life in patients following replantation of the distal half of the forearm (except fingers): A review of 11 cases.

The aims of this study were to evaluate the function and quality of life in patients who have undergone replantation of the hand or forearm. We carried out a retrospective single-center study of cases performed between 1977 and 2015. Our hospital's database was searched for patients who underwent replantation of the distal half of the forearm and hand (except the fingers). The evaluation included sensitivity, joint mobility, strength and quality of life. Conventional functional scores were used. Seventeen replantation cases were identified. Four patients were lost to follow-up. Of the 13 available patients, two suffered a replantation failure. Ultimately 11 patients were included in the study. Three patients were evaluated based on their medical records and eight were reviewed in person. The mean patient age was 31±11.8 years. The sensory evaluation resulted in five patients being classified as S1 and one as S3+. The mean Kapandji score was 4.3±2.3 [0-6]. The mean grip strength was 39.4±20% [0-80], and the pinch strength was 36.2±16% [0-60] compared to the healthy contralateral side. The mean DASH was 36.2±30.4 [4.5-79.5]. According to Chen's classification, two patients were at stage IV. For 50% of patients, the overall quality of life was at least equivalent to that of the general population. Replantation of the distal half of the forearm and hand should be attempted whenever possible. Although replantation causes some disability, good quality of life seems to be maintained.

[Fat grafting in breast reconstruction. Retrospective study of satisfaction and quality of life about 68 patients]. / Lipofilling en reconstruction mammaire. Étude rétrospective de la satisfaction et de la qualité de vie à propos de 68 patientes.

BACKGROUND: Evaluate the aesthetic clinical results, satisfaction and quality of life related to health in patients who underwent breast reconstruction by exclusive lipofilling or in addition to other surgical techniques. MEANS AND METHODS: A retrospective observational study was carried between 2009 and 2014 in four groups of patients who underwent a lipofilling by the same operator either after a conservative treatment (group 1), or exclusively (group 2), or after a flap (group 3) or implants (group 4). The sociodemographic data related to lipofilling or tumor pathology were collected and reported in a software designed for this study. Satisfaction and quality of life after lipofilling was assessed using the questionnaire Q BREAST(©) postoperative reconstruction module. RESULTS: One hundred and seventy lipofilling procedures were performed in 68 patients. The average volume transferred was 1421.2cm(3) for the exclusive lipofilling group and the average number of sessions was 4.9 spread over a period of 15.6months on average. In adjuvant technique or conservative surgery, the average total volume transferred was 212.2cm(3) and the average number of sessions was 1.4. The abdomen was the site most used donor and the posterior thigh exclusively used in exclusive reconstruction. The cytosteatonecrosis rate was 8.8 % (n=6). A single case of infection was noted. The tumor recurrence at ten months after lipofilling concerned two patients. The response rate was 80.8 %. The lipofilling improves the final cosmetic result with a rate of 91.1 % of patients satisfied or very satisfied with their breast. In all, 95.4 % of patients in the exclusive lipofilling group found a secondary benefit after surgery. Quality of life after lipofilling is also improved socially and sexually in the four groups with better results in patients who underwent conservative treatment. CONCLUSION: The lipofilling is a simple, reliable technique, requiring a learning curve, improving the final aesthetic result and the quality of life it is used exclusively or to complement other techniques.

[Benefit of simultaneous contralateral breast symmetry procedure with unilateral breast reconstruction using DIEP flaps. About 33 cases]. / Intérêt de la symétrisation immédiate au cours de la reconstruction mammaire unilatérale différée par DIEP. À propos de 33 cas.

BACKGROUND: After unilateral breast reconstruction, a procedure on the contralateral breast is often needed to achieve symmetry. Here, we present a single surgeon's experience with performing contralateral symmetry procedures simultaneously with DIEP flap. METHODS: We evaluated 33 consecutive patients (mean age, 52.1 years) who underwent DIEP flap unilateral breast reconstruction and a simultaneous contralateral breast procedure performed and 2 patients with delayed controlateral symmetry procedures. A single-stage breast cancer reconstruction is successful if after the original reconstruction no correction for revision of breast mound, or contralateral breast procedures are performed, under general anesthetic, to complete the reconstruction. RESULTS: In 24 patients (73%), breast reconstruction was completed after a single stage with one general anesthetic, and in 8 patients (24%), revisions were performed with two general anesthetic (7 patients) and three general anesthetic in one case. Reconstructions requiring more than one general anesthetic were due to 4 of 39 (10%) postoperative complications. Mean operating time was 485 minutes. CONCLUSIONS: For patients who need contralateral reduction mammoplasty or mastopexy for symmetry, performing these procedures and breast reconstruction simultaneously facilitates single-stage breast reconstruction in most patients.

Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations.

OBJECTIVES: Smoking patients undergoing a plastic surgery intervention are exposed to increased risk of perioperative and postoperative complications. It seemed useful to us to establish an update about the negative impact of smoking, especially on wound healing, and also about the indisputable benefits of quitting. We wish to propose a minimum time lapse of withdrawal in the preoperative and postoperative period in order to reduce the risks and maximize the results of the intervention. METHODS: A literature review of documents from 1972 to 2014 was carried out by searching five different databases (Medline, PubMed Central, Cochrane library, Pascal and Web of Science). RESULTS: Cigarette smoke has a diffuse and multifactorial impact in the body. Hypoxia, tissue ischemia and immune disorders induced by tobacco consumption cause alterations of the healing process. Some of these effects are reversible by quitting. Data from the literature recommend a preoperative smoking cessation period lasting between 3 and 8 weeks and up until 4 weeks postoperatively. Use of nicotine replacement therapies doubles the abstinence rate in the short term. When a patient is heavily dependent, the surgeon should be helped by a tobacco specialist. CONCLUSIONS: Total smoking cessation of 4 weeks preoperatively and lasting until primary healing of the operative site (2 weeks) appears to optimize surgical conditions without heightening anesthetic risk. Tobacco withdrawal assistance, both human and drug-based, is highly recommended.

Smoking and plastic surgery, part II. Clinical implications: a systematic review with meta-analysis.

OBJECTIVES: Tobacco addiction is a risk factor for complication in plastic surgery. The authors have assembled concrete arguments detailing the risks of perioperative and postoperative complication that are incurred by a patient with continued tobacco intoxication who wishes to undergo a surgical intervention. RESEARCH STRATEGY: Through application of the PRISMA criteria, we have carried out a systematic review of the literature, in which we explored five databases while using predefined keywords. We selected randomized, controlled observational studies on the perioperative and postoperative complications related to tobacco use in actively smoking, abstinent and non-smoking patients. DATA COLLECTION AND ANALYSIS: The levels of evidence for each article were evaluated. Risk of bias was assessed using the Newcastle-Ottawa Scale. Incidence parameters including the Odds Ratio and relative risk were calculated for each complication of which the number of occurrences had been indicated. Meta-analysis of the results was carried out. RESULTS: We included 60 observational studies. In the cosmetic surgery group, we calculated a combined Odds Ratio of 2.3 [1.51-3.54] P<0.001 for surgical site infections and 2.5 [1.49-4.08] P<0.001 for delayed wound healing. In the bariatric surgery sequelae group, we found a combined Odds Ratio of 3.3 [1.90-5.64] P<0.001 with regard to delayed wound healing and 3.1 [1.39-7.13] P=0.006 for cutaneous necrosis. No proof was provided as to the possible influence of tobacco on the success rate of free flap microsurgery, but it is difficult to extrapolate results on the latter to digital reimplantation. CONCLUSIONS: The review underlines the fact that patients with smoking habits run a significantly heightened risk of cutaneous necrosis, particularly in the event of major detachment (cervico-facial lift, skin-sparing mastectomy, abdominoplasty), of additionally delayed wound healing and of addition surgical site infections. Rigorous preoperative evaluation of smokers could help to diminish these risks.

Woodworking injuries: a comparative study of work-related and hobby-related accidents.

The primary objective of this study was to describe the injury characteristics and demographics of patients injured during woodworking activities, upon their arrival to the emergency department in a regional of France where this industry is prevalent. The secondary objective was to compare patient and injury characteristics for work-related and hobby-related accidents. A cohort of 87 patients who had suffered a woodworking accident over a two-year period was evaluated; 79 were available for follow-up. The context and circumstances of the accident, nature and location of the injuries and patient demographics were recorded. Hobby-related accidents accounted for two-thirds of the accidents (51/79). Most of the injured workers were either loggers (35%) or carpenters (46%). The hand was injured in 53 cases (67%). Work-related accidents resulted in significantly more serious consequences in terms of hospital stay, work stoppage, resumption of work or retraining than hobby-related accidents. For the workplace accidents, 86% occurred on new machines; more than 25% of the machines involved in accidents at home were over 15 years. Sixty-eight per cent of workers were wearing their safety gear, while only 31% of those injured during recreational woodworking wore the appropriate gear. Several elements of prevention should be improved: information about the need to maintain the equipment, protect the worker with suitable clothing, and learn which maneuvers are considered hazardous. Safety gear should be regularly inspected in the workplace.

PIP breast implant removal: a study of 828 cases.

In March, 2010, the French Health Products Safety Agency suspended the sale of prefilled silicone breast implants manufactured by Poly Implants Prosthèse Prothese (PIP) because of a high failure rate and the use of an inappropriate silicone gel that did not comply with CE marking. These findings led to an international medical crisis. In France, 30,000 female patients had PIP implants. In our Department, 1150 PIP breast implants had been implanted in 630 patients since 2001. A retrospective study was conducted to define the rupture rate of these implants and the complications that arise. The women included in the study underwent implant removal from May 2010 to September 2012 for preventive or curative reasons. Data were collected from medical records that included: results of clinical examination, breast ultrasound before removal, rates of implant rupture, results of biopsy of periprosthetic capsule and pericapsule tissue and postoperative complications. A total of 828 PIP breast implants were removed in 455 patients. The rate of ruptured implants was 7.73% (64/828), corresponding to 11.6% of patients. A periprosthetic effusion was associated with rupture in 44% of cases. Breast ultrasound indicated a rupture for 87 implants; 32% were true positives and 3% were false negatives. Periprosthetic capsule biopsy demonstrated the presence of a foreign body, which seemed to be silicone, in 26% of cases and the presence of inflammation in 13% of cases. No siliconoma-type lesion was identified in the pericapsular tissue at biopsy. A total of 14 implants presented perspiration at removal. A statistically significant difference was found between the rates of rupture for texturised implants as compared to the smooth-surfaced implants. There were eight post-revisional-surgery complications (1%) and three cases of breast adenocarcinoma. The preventive explantation of PIP breast implants is justified given the high failure rate (7.73%) and given patients' exposure to silicone gel that did not comply with CE standards in the absence of rupture, through the early perspiration of implants.

[Emergency free flap in reconstruction of the lower limb. Thirty-five years of experience]. / Reconstruction des pertes de substance de membres inférieurs par lambeau libre en urgence. À propos de 35ans d'expérience.

Authors analyzed 89 cases (86 patients) of lower limb extensive soft tissue defects reconstruction during 1978 to 2013. The mean age is 37 years and 2 months old (range: 5-84 years old). A total of 71 males and 15 female were included. Free flaps were used in emergency in 23 cases for principally covering Gustilo 3B open lower limb fracture and in a later stage for 66 cases all referred from their center for coverage of exposed bone, with frequently osteomyelitis. About the selection of free flaps, in 47 cases we used a latissimus dorsi flaps, 12 cases of epiploon free transfer (in septic area), 10 cases of gracilis transfer and 10 serratus anterior flaps. There are one medial gastrocnemius flap, 2 composite soleus and fibular free flap, 2 antebrachial flap, one inguinal myoosteocutaneous flap, 1 transferred from the other lower limb and one inguinal cutaneous flap. There are 18 free flap losses: one in emergency and 17 after delayed reconstruction. Authors retrospectively analyzed the results (complications, osteomyelitis) according to the timing for lower extremity reconstruction. They found a low infection and flap failure rates (4%) when the coverage is made in the same operating time than initial fracture fixation, they increase to 60% for osteomyelitis and to 23% for flap failure when the reconstruction is delayed.

[Abdominal perforator flap (DIEP) and autologous latissimus dorsi in breast reconstruction. A retrospective comparative study about the first 60 cases of a same surgeon]. / Le lambeau perforant abdominal (DIEP) et grand dorsal autologue en reconstruction mammaire. Étude rétrospective comparative à propos des 60 premières patientes d'un même opérateur.

INTRODUCTION: Autologous techniques for breast reconstruction get the best cosmetic results. Aesthetic satisfaction with breast reconstruction is an important evaluation criterion. The indication is based on technical criteria (morphological, medical history) and the wishes of the patient. A rigorous evaluation of the results is necessary to assist the patients in their choice of reconstruction. METHODS: Thirty-three DIEP and 27 latissimus dorsi were involved. A satisfaction questionnaire was sent to patients to collect the aesthetic evaluation of their reconstructed breast, sequelae at the donor site of the flap as well as their overall satisfaction. Post-operative photographs of the patients were subject to aesthetical evaluation by two groups of observers. Complications were analyzed. RESULTS: The DIEP tends to get higher aesthetic satisfaction regarding the symmetry of the breasts and the volume of the reconstructed breast (P=0.05), and a better overall satisfaction (P=0.02). The uniformity of the colour of the reconstructed breast was considered superior by observers in the latissimus dorsi group (P=0.005). Donor site scar of DIEP was considered more unsightly while the latissimus dorsi was considered more painful (P=0.04) and uncomfortable, with more frequently contour abnormalities (P=0.03). We noted two total flap necrosis and three partial necrosis in the group DIEP, and two partial flap necrosis in the group latissimus dorsi. CONCLUSION: This study provides evidence that can guide the patient and the surgeon in the complex process of therapeutic decision, without exempting the latter from a careful selection of indications.

[Characteristics of Dupuytren's disease in women. A study of 67 cases]. / Particularités de la maladie de Dupuytren chez la femme. À propos de 67 cas.

OBJECTIVES: The aim of this study was to identify the clinical differences of the Dupuytren's disease in gender. Testosterone induces an increase of the Dupuytren's fibroblast proliferation via androgen's receptors. Testosterone rate increases during pregnancy and menopausis. We also reached a link between this factors and the clinical aspects of Dupuytren' disease in the women of our study. METHODS: This retrospective, comparative study was about all women and a randomized number of men, who underwent surgery for Dupuytren' disease between 1980 and 2010. We analysed all the epidemiologic and clinical data, the surgery procedures and the complications. Pre- and postoperative measurements of the extension lack of all the joints were performed with a manual goniometer. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate the patients function. This specific data of women were reached. RESULTS: Sixty-seven women and 69 men were compared. The complex regional pain syndrome was significantly more common in women and the correction of the proximal interphalangeal joint was significantly lower in women. Recurrence rate and mean follow up were not statistically different. Mean DASH score was higher in women. We have not found any association between menopausis, pregnancy and the average age at presentation of the disease, the recurrence rate or the extension rate. CONCLUSIONS: The prognosis of the Dupuytren's disease is worse in women than in men. Other studies are necessary to reach the link between the testosterone and the clinical history of the disease in women.

[Macro-replantation of the upper limb: long-terms results and quality of life]. / Macro-replantation du membre supérieur: résultats à long terme et évaluation de la qualité de vie.

OBJECTIVES: The authors suggest standardized questionnaires of quality of life to perform a long term evaluation of patients who underwent a replantation of the proximal upper limb. METHODS: This retrospective study is about patients who underwent a replantation of the proximal upper limb between 1979 and 2011. The functional assessment was conducted using several tools including the 400 points test, the sensory tests, the Disabilities of the Arm, Shoulder and Hand questionnaire and the CHEN's classification. Some questionnaires, like the Medical Outcome Study Short Form-36 dealt with the physical and the psychological sides of the quality of life. Other questionnaires were more specific, like the Body Image Scale. RESULTS: Sixteen patients were included. The survival rate of the replanted limb was 75%. The mean follow-up was 12.7 years. We noted 20% good results with a mean DASH score to 24.5%. The quality of life was similar to the general population in most of 50% of cases. Some patients had depressive symptoms or body image troubles. CONCLUSIONS: In our eyes, the evaluation of quality of life seems essential for these patients. Survival rates, functional results, follow-up, professional activity, gender and body image troubles influence the quality of life. Besides, the physical side and the psychological side must change together to affect the overall results of the quality of life.

Treatment of trapeziometacarpal osteoarthritis by partial trapeziectomy and costal cartilage autograft. A review of 100 cases.

PURPOSE: Trapeziectomy remains the surgery of choice in the treatment of trapeziometacarpal osteoarthritis. Some authors consider the collapse of the trapezial space responsible for a loss of strength and intracarpal deformities. We report our experience of partial trapeziectomy with chondrocostal autograft as an interposition material. METHODS: The study included100 thumbs in 82 patients with a mean age of 64.6 years (47-82). Mean follow-up was 68 months (4-159). Partial trapeziectomy was carried out through a dorsal approach. The graft was harvested through a direct approach of the 9th rib. RESULTS: Our results were similar to those obtained with alternative techniques, except for strength where the gain is improved. No intracarpal deformities were seen. There was no sign of graft wear; the length of the thumb ray is preserved. The results are stable over time, and the morbidity of the costal donor site is negligible. The interposition of a hardwearing biological material and its association with partial trapeziectomy enable to restore the thumb stability and strength.

[Induced membrane technique for the reconstruction of bone defects in upper limb. A prospective single center study of nine cases]. / Reconstruction des pertes de substance osseuse du membre supérieur par la technique de la membrane induite, étude prospective à propos de neuf cas.

INTRODUCTION: Bone defect in the upper limb remain infrequent with few reported in the literature. Their reconstruction raises the problem of bone union of non weight-bearing segments as well as the function of adjacent joints. We report a monocentric continuous series of nine patients treated with the induced membrane technique (Masquelet technique). PATIENTS AND METHODS: Nine patients with a mean age of 39.2 years (17-69) presented with a bone defect of the humerus (six cases) or one of two bones (three cases). Diaphyseal (six cases) or metaphyseal (three cases) defects were secondary to trauma in three patients, to non-union in four others and following tumors for the other two. The mean defect was 5.1cm (2.5-9). Reconstruction was done by initial filling using a spacer in cement, followed by a cancellous bone graft within the induced membrane. BMP's growth factor was used in two cases. RESULTS: Bone union was achieved in eight out of nine cases with a follow-up of 23 months (8-52) after the first stage, and 17 months (6-49) following filling by the graft. One patient did not want the second stage done before one year. The failure was in a very non-compliant patient who had a bone substitute associated with aBMP. Two septic non-unions were cured. Shoulder and elbow functional outcomes were comparable to the controlateral side for humeral defects; pronosupination decreased by 17% for the cases of reconstruction of two bones. DISCUSSION: The technique of the induced membrane allows filling of a large bone defect, while avoiding vascularised bone autografts and their morbidity. It requires two procedures but can be used in emergency or after failure of other interventions. It is a reliable, and reproducible technique where the only limit is the cancellous bone stock. Following the series of Masquelet, Apard and Stafford in the lower limb, and the series of Flamans in the hand, this is the first report of reconstruction of defect in the upper limb using this technique.

Post-traumatic malunion of the distal radius treated with autologous costal cartilage graft: a technical note on seven cases.

UNLABELLED: Seven cases of post-traumatic intra-articular malunion of the distal radius treated using costal cartilage graft with a minimum follow-up of 2 years are reported. Location of the articular defect was dorsal in two cases and volar in the others. The approach (dorsal or volar) depended on the main location of the defect. A costal cartilage graft harvested on the eighth rib was implanted in a trough created at the epiphysis metaphyseal junction. This trough removed the defective area on the distal radius articular surface. A plate or wire fixation was used to stabilize in place the graft. Plaster cast wear was prescribed for 3 months in the first case and for 1 month in the other cases following joint reconstruction. No complications were observed. Union was achieved in all seven cases. Graft integration and viability were evaluated with MRI and biopsy. At the longest follow-up, the functional results were excellent in the first (youngest) case (male, 22 years old) in whom motion and grasp were similar to the contralateral side. In the other cases of malunion, the patients were pain-free in daily activities with a functional wrist score of 72/100 (range, 54-82) and a DASH score of 38.3 (range, 22.5-51.7). Only the case with a septic problem failed, with pain reported at follow-up. Reconstruction of a partially destroyed articular surface using a costal graft is reliable and allows filling and resurfacing an articular cartilage void. Although costal cartilage graft is currently used in maxillofacial surgery, this is the first report in post-traumatic osteoarthritis secondary to intra-articular malunion. LEVEL OF EVIDENCE: Level IV.

[Baropodometric analysis of the functional donor-site morbidity after gastrocnemius or soleus muscle-flap procedure]. / Analyse baropodométrique des séquelles fonctionnelles liées au prélèvement des lambeaux gastrocnémiens et soléaire.

The triceps surae muscle is a major donor-site for muscle-flap to cover soft-tissue defects of the leg. There are very limited datas on the functional donor-site morbidity in the literature. From a retrospective study on 14 patients, we realized a baropodometric analysis comparing the operated lower limb with the healthy non operated side and a functional evaluation by a questionary. The modified functional score of Kitatoka was good (87/100). Ninety percent of the patients were able to resume a professional activity and 2/3 to resume the sport. The baropodometric analysis did not show statistically significant difference of propulsion and absorption between the healthy side and the operated side, but a modification of the programming of the step. The absence of important functional donor-site morbidity is probably bound to a compensation of the remaining triceps surae muscles and/or to mechanisms of adaptation. Our study confirms the little functional donor-site morbidity of the partial triceps surae muscle-flap procedure. These flaps remain a good solution for the coverage of the soft-tissue defects of the leg.

[Giant abdomino-pubic melanoma. A case report]. / Mélanome géant abdomino-pubien. À propos d'une observation clinique.

Cutaneous melanoma patients are usually young adults. The evolution into a nodular form darkens the prognosis because it increases the risk of metastasis occurrence. The only curative treatment is wide surgical excision when extension check is negative. We report a case of abdomino-pubic melanoma original by its amazing size, its spreading, both superficial and nodular, without metastasis, and its late occurrence to a senior patient. Curative management was performed with a plastic surgery technique: the abdominal plasty. The melanoma was removed with free margins and the patient was free of disease at six month. This report illustrates the interest of plastic surgery techniques in oncology. It also confirms that plastic surgeon forms an integral part of a multidisciplinary team managing patients with cutaneous melanoma.

Emergency management of traumatic collateral palmar digital nerve defect inferior to 30 mm by venous grafting. Report of 12 clinical cases.

INTRODUCTION: When traumatic collateral palmar digital nerve defect occurs, emergency venous grafting is an alternative to the two-step nervous grafting procedure. METHODS: During the course of a monocentric retrospective study, 12 cases of emergency venous grafting were reviewed by a single independent examiner 11 months, at least, post-intervention. Clinical and functional evaluation was carried out, together with a self-assessment of the results by the patient. Data were compacted using a filtering method and the final result was considered in terms of "good" or "bad". RESULTS: Good result was observed in ten cases out of 12. Bad results were associated with poor sensory recovery in the two other cases. In one of these, the bad result was also related to severe symptoms in cold conditions and a troublesome hyperesthesia. DISCUSSION: Through a review of the literature, we justify the emergency treatment of nerve defects of the collateral palmar digital nerves with venous grafting.

[Osteoarthritis of the trapeziometacarpal joint in men: different stakes. Results of three surgical techniques]. / La rhizarthrose chez l'homme: des enjeux différents. Résultats de trois techniques chirurgicales.

Basal thumb arthritis is less common in men, but the functional implication is different in this manual worker or active retired population. The objective was to analyse the results of three surgical procedure in an exclusively men's population. Twenty-eight patients (19 partial trapeziectomy with interposition of a chondrocostal autograft, seven total trapeziectomy and two prosthesis), with a mean age of 69 years old, were reviewed at a mean follow-up of 71 months. Mobility and pain were similar in the three populations. But the strength and Dash scores were better in the cartilage group. Radiologically the length of the thumb ray was greater in the cartilage group and no signs of loosening were observed in the prosthesis group. The surgery of reference in this population is the arthrodesis of the trapeziometacarpal joint. But the lack of mobility is disabling, the strength is questionable and painlessness varies due to high rates of non-union. Only one study compared four surgical procedures in an exclusively male population and total trapeziectomy seemed to give the best results. But this technique carries risk of shortening of the thumb ray. Even if the comparison is difficult, the association of partial trapeziectomy with interposition of costal cartilage graft seems to give better stability to the thumb column by preserving length as well as greater strength compared to total trapeziectomy. We advocate this procedure for basal thumb arthritis in men.

[Use of the induced membrane technique for the treatment of bone defects in the hand or wrist, in emergency]. / Pertes de substance osseuse à la main et au poignet traitées en urgence par technique de la membrane induite (technique de Masquelet).

A prospective study is reported concerning 11 cases of bone defect of the hand and wrist treated by the induced membrane technique. Ten men and one woman with an average age of 49 yrs (17-72) sustained a high-energy trauma with severe mutilation of digit and hand but with intact pulp. Eight cases of open finger fractures with composite loss of substance and three cases of bone and joint infection (thumb, wrist, fifth finger) were included. All cases were treated by the induced membrane technique which consists in stable fixation, flap if necessary, and in filling the bone defect by a cement methyl methacrylate polymere (PMMA) spacer. A secondary procedure at two months is needed where the cement is removed and the void is filled by cancellous bone. The key point of this induced membrane technique is to respect the foreign body membrane which formed around the cement spacer creating a biologic chamber. Bone union was evaluated prospectively by X-ray and CT scan by a surgeon not involved in the treatment. Failure was defined as non-union at one year, or uncontrolled sepsis at one month. Two cases failed to achieve bone union. No septic complications occurred and all septic cases were controlled. In nine cases, bone union was achieved within four months (three to 12). Evidence of osteoid formation was determined by a bone biopsy in one case. Masquelet first reported 35 cases of large tibial non-union defects treated by the induced membrane technique. The cement spacer promotes foreign body membrane induction constituting a biological chamber. Works on animal models reported by Pellissier and Viateau demonstrated membrane properties: secretion of growths factors (VEGF, TGF beta1, BMP2) and osteoinductive cellular activity. The induced membrane seems to mimic a neoperiosteum. This technique is useful in emergency or septic conditions where bone defects cannot be treated by shortening. It avoids microsurgery and is limited by availability of cancellous bone.