"Reposition-flap": A therapeutic alternative in fingertips amputations.

After trans-phalanx fingertips amputations, there is usually a therapeutic problem related to the distal fragment quality. Replantation is not always possible. The aim of this study was to propose the "reposition-flap" surgical procedure as an alternative solution to various surgical strategies for distal stump coverage. It consisted in the association of a bone fragment osteosyntesis and a pedicular local flap implementation. Between 2001 and 2011, the reposition-flap surgical procedure was retrospectively tested in two hand trauma centers. We reviewed a cohort of 51 patients divided in two groups. The first one (20 patients) was the "reposition-flap" group, the second (31 patients) had a coverage with an other surgical procedure (simple regularisation or local flap). Sensibility, pulp trophicity, fingers mobility, digital length, nail appearance and radiologic consolidation of each patient were reviewed. "Reposition-flap" allowed 80% length of phalanx conservation. In comparison with regularisation, the aesthetic aspects of the nail's finger (no claw) were improved with this surgical procedure. However, the Quick DASH average revealed significant statistical differences instead of the statistics obtained with the mobility of the IPD and the sensitivity of the pulp. This procedure gave best aesthetic and functional results.

Fingertip reconstruction by palmar bipedicular island flap in long fingers (modified neurovascular Tranquilli-Leali flap): A dual-center study.

When bone is exposed, fingertip defects may require a flap procedure. Many types are available, with little consensus about which one is best. But each one has its own disadvantages: esthetic (claw nail deformity), neurological (sensory disorders) or functional (stiffness). The purpose of this study was to evaluate a palmar bipedicular island flap (our modification of the Tranquilli-Leali flap) for fingertip reconstruction. We retrospectively analyzed the prospective data of 42 patients with a mean follow up of 16.4 months (6-30 months) operated in two hospital facilities. Thirty-three patients were men. Mean age was 39.5 years (12-83 years) and 24 (57.1%) were smokers. In 23 cases (54.8%), the trauma was work-related. A crush mechanism was identified in 29 patients (69%). According to Allen's classification of fingertip injuries, there were 26 cases of stage II, 14 cases of stage III and 2 cases of stage IV. All procedures were performed on an emergency basis, within 24 hours of the trauma. No claw nail deformity was observed. The mean discrimination in the Weber test was 3.8mm (2-6mm). The mean Total Active Motion (TAM) was 268.3° (255-275°). The patient satisfaction was graded at 8.7 on a 10-point scale. Results were considered as excellent in 15 cases and good in 23 cases. The modified palmar bipedicular island flap makes the old Tranquilli-Leali flap - which has a poor reputation in the hand surgeon community-simpler and safer to use. This flap restores proper balance between skin, bone and nail in Allen stage II and III fingertip amputations.

[An optimum donor site for venous grafting for microsurgery]. / Un site optimal de greffons veineux microchirurgicaux (étude anatomique des veines satellites de l'artère radiale).

We report the results of an anatomic study based on 10 cadavers. The aim of this work is to find an optimum donor site for venous grafts which is safe, reproducible, and suitable for microsurgery stitches especially in finger reimplantation, when a long and small calibre graft is needed. This study describes the deep venous network of the radial artery, an original donor site for microsurgical venous grafts. The second aim is to describe our technique of harvesting. Dissections always show two satellite veins, that can be harvested with optimal average diameter of 1.8mm constant over the whole length. The maximum length available is about 126.5mm for the radial satellite vein, and 125 mm for the ulnar one, with a few number of collateral ligatures needed. No tying is required in 60% cases for radial satellite vein, and one ligature for the other 40%, whereas in the ulnar satellite vein, no tying is needed in 80% and just one in the other 20%. This original site is advantageous in microsurgery of the upper limb, offering an easy, quick, safe and reproducible option in an emergency situation.

Isolated scaphoid fracture with anterosuperior dislocation of the proximal fragment.

Isolated fracture of the scaphoid with an associated anterosuperior dislocation of the proximal fragment is an extremely rare injury. We present two cases where open reduction and internal fixation through a palmar and dorsal approach was performed. No instances of non-union, necrosis of the proximal fragment of the scaphoid or scapholunate dissociation were noted during a mean follow-up period of 18 months. Clinical results (active motion, power grip, DASH) following such injury and intervention are presented. The aetiology of this rare injury is discussed.

[Arthroscopic treatment for Preiser's disease by partial resection of the scaphoid and pyrocarbone's implant, preliminary results: a case report and literature review]. / Maladie de Preiser traitée par résection partielle du scaphoïde sous arthroscopie et implant en pyrocarbone, résultats préliminaires : à propos d'un cas, et revue de la littérature.

Idiopathic avascular necrosis of the scaphoid, also called Preiser's disease, has been diagnosed in only 150 cases. Its clinical and radiological description is well established, but there is no consensus regarding its treatment. We report the case of a 53-year-old woman, with an advanced disease; treated arthroscopically by partial resection of the scaphoid, and insertion of an adapted pyrocarbon implant. Preliminary results at 6 months were satisfying in terms of pain. However, there was little improvement in range of motion, with a final range of 150°.