Antonio de Gimbernat and his time in Madrid: The Royal College of Surgery of San Carlos

The transformation of Spanish Surgery in a modern scientific discipline takes place within the Royal Colleges of Surgery, and in all of them the figure of Antonio de Gimbernat and Arbós stands out over the rest. After completing his studies at the Royal College of Surgery of Cadiz (Real Colegio de Cirugía de Cádiz), under the tutelage of Pedro Virgili and his teaching and surgical work at the Royal College of Surgery of Barcelona (Real Colegio de Cirugía de Barcelona), it is in his almost forty years of stay in Madrid when the surgeon reaches his highest scientific and professional achievements. In these years, he is responsible for the creation, operation and development of the Royal College of Surgery of San Carlos (Real Colegio de Cirugía de San Carlos), and it is then when most of his rare but important publications were released, such as the ‘New method for operating the crural hernia’, whereby Gimbernat is considered the father of the modern surgery of this pathology. Unfortunately, the socio-political circumstances, the state of international isolation of the country and the unfair treatment received by Antonio de Gimbernat in the last years of his life diminished the impact of the work and studies of the man who for many has been the most illustrious surgeon of this country (AU)

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Cauterization of the germinal nail matrix using phenol applications of differing durations: a histologic study.

BACKGROUND: Phenol has been used for more than 60 years in the treatment of ingrown toenails. Many reports have documented the safety and effectiveness of phenol matricectomy, although with variable treatment application times. OBJECTIVE: We performed research to determine the application time required for phenol matricectomy for complete denaturation of the nail matrix to occur at a concentration of 88%. Identifying the optimal time required to destroy the germinal matrix without causing further soft-tissue damage should reduce the potential for complications. METHODS: Thirty anatomic cadaveric fresh hallux samples were used to perform phenol matricectomy. The applications were for 1 to 6 minutes using 10 samples per time point and analyzed by hematoxylin-eosin staining to determine the presence or absence of the basal or germinal layer of the nail bed epithelium (NBE). RESULTS: After a 1-minute application of 88% phenol solution, only superficial damage to the NBE was noted, with the basal layer primarily intact. After a 2-minute application, the nail plate was avulsed with a thin basal layer remaining. After a 3-minute application, full-thickness necrosis of the NBE was noted in 6 of the 10 specimens. After 4-, 5-, and 6-minute applications, full-thickness necrosis of the NBE was noted and the basal layer was completely destroyed in all 30 specimens. LIMITATIONS: The study was performed in cadaveric fresh specimens. CONCLUSIONS: Application of 88% phenol solution for at least 4 minutes is necessary for complete destruction of the nail matrix, creating an environment that avoids nail regrowth.

Debunking myths and building realities: Human body donation in times of crisis

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Use of a Kirschner wire for distraction and capsular flaps in the Keller interpositional arthroplasty.

We describe a simplified capsular interpositional technique for the Keller bunionectomy that uses a Kirschner wire to interpose the capsule into the first metatarsophalangeal joint without requiring sutures. The capsule acts as a biologic spacer in the first metatarsophalangeal joint, allowing for fibrosis to fill the void created, with the Kirschner wire maintaining the distance between the metatarsal head and the stump of the proximal phalanx. This creation of a nonpainful pseudarthrosis prevents shortening of the hallux and retraction of the base of the proximal phalanx on the metatarsal head.

Transfer of the flexor digitorum brevis tendon.

BACKGROUND: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw or hammer toe deformities. In contrast, a search of the literature revealed no previous reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions. We performed a cadaver study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect. METHODS: Transposition of the flexor digitorum brevis tendon was attempted in 180 toes of cadaver feet: 45 second toes, 45 third toes, 45 fourth toes, and 45 fifth toes. RESULTS: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes and in 42 (93.3%) of the fifth toes. In the three remaining fifth toes (6.7%), the flexor digitorum brevis tendon was absent, a known anatomical variation. CONCLUSIONS: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for correction of claw or hammer toe deformities, especially in the second, third, and fourth toes. The transverse aponeurotic fibers originating from the extensor digitorum longus impede the transfer of the flexor digitorum brevis tendon, and meticulous excision of these fibers is essential to the success of the procedure.

Arthroscopic study of the knee joint in fetuses.

PURPOSE: The purpose of this study was to macroscopically examine the fetal knee joint via arthroscopy. We have attempted to identify and describe the specific characteristics of the fetal knee joint, how it evolves during the last few weeks of intrauterine development, and any possible variations with regard to the adult knee. TYPE OF STUDY: Observational anatomic case series. METHODS: We used 20 frozen fetuses with a gestational age of 24 to 40 +/- 2 weeks, obtained from spontaneous abortions. Examination was performed with standard arthroscopic surgical equipment, using a 2.7-mm optical lens. Whenever possible, we tried to use standard arthroscopic portals. Images were obtained for comparison with the adult knee. RESULTS: Suprapatellar and infrapatellar septa were an almost consistent finding. The suprapatellar septum always opened laterally and was intact in the developmentally younger specimens. We found 2 mediopatellar septa. The femoral attachment of the anterior cruciate ligament (ACL) differed in appearance from that of the adult in that it was more ribbon-like. The lateral meniscus had a more spread-out appearance than its adult counterpart, especially in the specimens of a younger gestational age. We were surprised at the easy accessibility of the popliteal hiatus and the clear arthroscopic vision we were able to obtain of the involved structures. CONCLUSIONS: To our knowledge, this is the first arthroscopic study to target the fetal knee. The results indicate minimal differences when compared with the adult knee, and for some structures, such as the popliteal hiatus, the anatomy seen was easier to discern than in adult knee arthroscopy.