Homodigital neurovascular island flaps in hand surgery. A study of sixty cases.

The homodigital island flap is a useful technique in problem cases such as distal amputation of the pulp, atrophic or insensative pulp on the index finger or thumb and painful neuromas. In a series of 60 operations preformed by one surgeon with the SOS Main in Strasbourg, we describe the indications for, and results of, several different techniques: unipedical flaps either advanced or "exchanged" and bipedical flaps either advanced or retreated.

[Hueston's flap for reconstruction of loss of distal thumb substance]. / Le lambeau de Hueston dans les recouvrements des pertes de substance distales du pouce.

The classical rotation flap described by J. Hueston involves the advancement of a denervated skin area on the distal stump. In distal amputations of the thumb, this flap should only be used on the lateral side in order to avoid creating a blind medial pulp. Furthermore, this leaves a proximal skin defect thereby exposing the neurovascular bundles. This secondary defect is best covered by a lateral triangular rotation flap.

Technique and indications of the forearm flap in hand surgery. A report of thirty-three cases.

The Chinese forearm flap is vascularized by the radial artery and may be used as an island or a free flap. Used as an island flap, the pitfalls of the microsurgical procedures required for a free flap, may be avoided. Vascular anastomosis is easily performed owing to the large diameter of the vessel. The possibility of using it as a composite flap with fascia, tendons, muscle, bone or nerve makes this flap a "must" in reconstructive surgery of the hand. A series of 33 cases was reviewed in an attempt to summarize their indications and contraindications respectively.

Single stage thumb reconstruction by a composite forearm island flap.

Single stage thumb reconstruction is possible with a new composite skin bone flap from the forearm. The primary vascularisation of skin and bone avoids the disadvantages of the conventional multi-staged procedures such as neurovascular insufficiency, infection and bone absorption. It does not require a surgical team with microsurgical expertise. The best indication is the reconstruction in the subtotal thumb amputation.

A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap.

The Chinese forearm flap based on the radial artery is extremely versatile. It can be used as an island-skin flap, a free flap or as a compound forearm flap including vascularised nerve, bone or tendons. This paper describes and discusses some of these applications and is based on a series of 17 patients who presented with problems of reconstruction in the hand.

The repair of peripheral nerve injuries in emergency.

Peripheral nerve injuries must be considered as serious surgical emergencies for they are often associated with vascular lesions. Primary repair of clean-cut injuries of peripheral nerves by microsurgical techniques yields better results than the best of secondary repairs.

Toe-to-hand transfers in reconstructive surgery of the hand. Experience with seventy-one cases.

Based on a homogeneous series of 71 toe-to-hand transfers performed between February 1975 and December 1982 the same surgeon, the authors have tried to define their present day indications. Technical modifications have been described for the second toe transfer : isolated dorsal approach of the toe with early-stage resection of the second metatarsal bone, utilisation of the plantar metatarsal artery of the second interosseous space, utilisation of the volar vessels for the anastomosis at the recipient site, dorsal subcutaneous tunnel for the venous anastomosis of the hand. Aside from the usual indications for thumb reconstruction (11 cases) and 26 cases of transfers for reconstruction in long finger injuries, the indications for partial transfers have become more and more frequent : pulpar (9 cases), pulp + bone + nail (10 cases), isolated nail (1 case), nail + bone (2 cases), first web space (1 case), double twisted toe (5 cases) and articular (6 cases) transfers.

[Ungual synthesis]. / La synthèse unguéale.

In case of dorsal sectioning of the distal phalanx, the nail can be used to mobilize and to bring the bone fragments together. A needle is passed through the nail and the nail bed, and the two fragments can be brought together with a metallic tension suture.

[Improvement of proximal interphalangeal flexion of the 5th finger in wounds or avulsions of the flexor profundus tendon]. / Amélioration de la flexion interphalangienne proximale du cinquième doigt dans les plaies ou avulsions du tendon fléchisseur profond.

The flexor superficialis of the little finger alone is frequently unable to provide good flexion of the PIP joint. This was verified in half of the hands tested in 45 normal volunteers. These data stress the mandatory repair of the flexor profundus tendon in emergency situations. In secondary reconstruction the authors advocate a side-to-side anastomosis between the sublimis and profundus tendons in order to reinforce the flexion of the PIP joint.

[Irreducible closed luxation of the distal interphalangeal joint. Apropos of 2 cases]. / La luxation fermée irréductible de l'articulation interphalangienne distale. A propos de deux observations.

Two irreducible dislocations of the distal digital interphalangeal joint have been seen by the author. One was dorsally displaced with interposition of the extensor tendon, and the other was a palmar displacement with interposition of the flexor tendon. Both cases were successfully treated by open reduction. A review of the literature confirms the rarity of this condition.

Free composite tissue transfer in a compound hand injury.

In a severe compound and contaminated injury of the hand with loss of soft and bony tissues, restoration of function was obtained by a free composite vascularised tissue transfer.

[Surgery of the intrathoracic goiter (author's transl)]. / De chirurgie van het duikend kropgezwel.

One is often obliged to resect intrathoracic goiters. This is not directed towards functional problems but towards the local compression on other organs in the vicinity. Goiters that extend through the cervicomediastinal inlet are of this kind. In cases where the major part is in the mediastinum there still exists a continuity with the cervical part. Most cases can be resected by a cervicostomy. The vascularization comes from the neck except in true thoraic goiters. This makes it possible to ligate the vessels before extracting the gland. In difficult cases a mid sternotomy may be useful so that all thoracic goiters can be operated safely.