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1.
Chir Main ; 31(2): 83-90, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22365321

ABSTRACT

OBJECTIVES: The purpose of this study was to identify the skills found most important to gain patient's trust from a patient's perspective. METHODS: One hundred and twenty-two patients were surveyed prospectively using a questionnaire assessing professionalism, physical environment, verbal and non-verbal communication skills. Factors required to establish a trusting patient-surgeon relationship were ranked in order of importance before and after initial consultation with a surgeon in a hand surgery clinic model. RESULTS: No significant relationship was identified between gender, age, education or income, and answers provided by respondents. Technical ability, verbal communication skills and respect of patient's autonomy by the physician were found most important. CONCLUSION: The visit with the surgeon significantly affected the ranking of some of the skills deemed important. Patients view respect of autonomy and verbal communication skills as the most important attributes when developing trust and confidence in a surgeon, followed by technical proficiency.


Subject(s)
Hand/surgery , Orthopedics , Physician-Patient Relations , Trust , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Surveys and Questionnaires , Young Adult
2.
J Plast Reconstr Aesthet Surg ; 64(7): 966-8, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21093395

ABSTRACT

Although microvascular free-tissue transfer has become a reliable reconstructive method, vascular compromise of the flap necessitating surgical exploration and attempts at flap salvage commonly occurs. Thrombectomy using Fogarty vascular catheters can be used in the setting of vascular pedicle thrombosis. However, this is not without potential complications. The following report describes a case in which the use of a Fogarty vascular catheter during a thrombectomy for microsurgical flap salvage resulted in complete separation of the balloon from the catheter.


Subject(s)
Catheterization/instrumentation , Equipment Failure , Microsurgery/adverse effects , Surgical Flaps/adverse effects , Surgical Flaps/blood supply , Thrombosis/therapy , Aged , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Catheterization/adverse effects , Device Removal , Follow-Up Studies , Forearm/blood supply , Forearm/surgery , Humans , Male , Microsurgery/methods , Mouth Neoplasms/pathology , Mouth Neoplasms/surgery , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Risk Assessment , Salvage Therapy/methods , Thrombectomy/methods , Thrombosis/etiology , Treatment Outcome
3.
J Hand Surg Eur Vol ; 35(6): 464-8, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20427405

ABSTRACT

We describe a variation in the A4 pulley reconstruction technique using one slip of the flexor digitorum superficialis insertion and report the results of a biomechanical analysis of this reconstruction in cadavers. While conserving the distal bony insertion, one slip of flexor digitorum superficialis is transferred over the flexor digitorum profundus tendon and sutured to the contralateral superficialis slip insertion. This creates a new pulley at the base of the original A4 pulley that can be adjusted to accommodate an FDP repair of increased bulk. We found a 57% reduction in excess excursion due to bowstringing when compared with no repair. Furthermore the repairs were sturdy, 94% of specimens maintaining their integrity when a proximally directed force of 50 N was applied.


Subject(s)
Finger Injuries/surgery , Tendon Transfer/methods , Biomechanical Phenomena , Cadaver , Humans , Suture Techniques , Tensile Strength
4.
Chir Main ; 29(2): 128-31, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20202882

ABSTRACT

We are reporting on a 72-year-old male who was diagnosed with Merkel cell carcinoma on the dorsal aspect of his left index finger. This rare highly aggressive malignancy of the skin has only exceptionally been described on the finger or hand. This case report helps review important findings associated with this rare malignancy and reviews the pertinent literature.


Subject(s)
Carcinoma, Merkel Cell/diagnosis , Carcinoma, Merkel Cell/surgery , Fingers , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Aged , Amputation, Surgical , Biopsy , Carcinoma, Merkel Cell/epidemiology , Diagnosis, Differential , Humans , Immunohistochemistry , Male , Rare Diseases , Risk Factors , Sentinel Lymph Node Biopsy , Skin Neoplasms/epidemiology
7.
Chir Main ; 26(4-5): 238-42, 2007.
Article in English | MEDLINE | ID: mdl-17920326

ABSTRACT

"Triggering of the fingers at the wrist" is a relatively unusual condition. It consists in a triggering at the wrist produced by finger motion. Its etiology and presentation may vary. This condition should be clearly differentiated from the other clinical entity called "trigger wrist", occurring on wrist movement. In the present article, we report the case of an anomalous flexor digitorum superficialis muscle belly, arising from the right ring finger at the carpal tunnel, in a 47-year old female patient, causing triggering of the right ring finger at the wrist and a carpal tunnel syndrome. Surgical excision of the muscle mass and carpal tunnel release relieved patient's symptoms and has led to the disappearance of the triggering phenomenon. To date, few cases of trigger finger at the wrist have been reported in the literature. These reported cases were reviewed. The clinical entity of "true trigger wrist" and its etiology are also discussed.


Subject(s)
Muscle, Skeletal/abnormalities , Muscle, Skeletal/surgery , Trigger Finger Disorder/surgery , Wrist/surgery , Decompression, Surgical , Female , Humans , Middle Aged , Trigger Finger Disorder/diagnosis
8.
Chir Main ; 25(2): 77-80, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16841768

ABSTRACT

INTRODUCTION: To determine if trabecular, total and cortical bone densities of the capitate, navicular, cuboid, and first cuneiform were equivalent to those of the scaphoid, such that these bones could be used in place of the scaphoid in evaluating new headless scaphoid compression screws. METHODS: Fifty scaphoids, capitates, naviculars, cuboids, and first cuneiforms were harvested from fresh frozen cadavers. The trabecular, total and cortical bone densities were measured using pQCT technology and statistically compared. RESULTS: A paired t comparison between paired scaphoids and capitates showed no difference between the trabecular bone densities. However, their total bone and cortical densities were found to be different. An independent measures ANOVA comparison of the five bones, showed no significant difference in mean trabecular density between the capitates, naviculars and first cuneiforms when compared to the scaphoids. However, the mean total and cortical densities of the first cuneiforms were less than the scaphoids and the mean trabecular, total and cortical bone densities of the cuboids were all less than the scaphoids. DISCUSSION: Compression fracture fixation studies of headless compression screws could be conducted using the capitate, navicular, and first cuneiform as models of the scaphoid when the supply of scaphoids is limited.


Subject(s)
Bone Density/physiology , Carpal Bones/physiology , Tarsal Bones/physiology , Aged , Bone Screws , Cadaver , Carpal Bones/anatomy & histology , Female , Fracture Fixation, Internal , Fractures, Compression/surgery , Humans , Male , Models, Biological , Tarsal Bones/anatomy & histology
9.
Acta Chir Belg ; 105(5): 551-3, 2005.
Article in English | MEDLINE | ID: mdl-16315848

ABSTRACT

Primary cutaneous mucormycosis is an uncommon, deep and aggressive fungal infection occurring mainly in immunosuppressed or diabetic patients. Rapid diagnosis and therapy are necessary to prevent a fatal outcome. An eight-year-old leukaemic child presented with a dark necrotic ulcer on the volar-ulnar aspect of the left forehand. The lesion had developed over seven days, beginning as a vasculo-haemorrhagic erythematous plaque. There was no known history of trauma to the area, but skin necrosis from external compression caused by an intravenous line could not be completely ruled out. The lesion rapidly progressed to a 5 x 8 cm painful necrotic ulcer with an erythematous border. Treatment with ichthyol dressing and intra-venous antibiotherapy failed to improve the condition. Wide debridement was performed and specimens were sent for microbiology and pathology examinations. Microscopic examination demonstrated broad, irregularly walled, non-septate fungal hyphae that were consistent with Mucor. Amphotericin B was administrated intravenously (1 mg/kg/day) and hydrogel and hydrophile adhesive polyurethane foam dressings were applied. After 12 days, the soft tissue defect was covered with a split-thickness skin graft, harvested from the lateral aspect of the thigh. Diagnosis of this infection is based on complete histopathological and microbiological studies. Awareness, and a high index of suspicion are required because of the potential fulminant and fatal course.


Subject(s)
Leukemia/complications , Mucormycosis/complications , Mucormycosis/etiology , Skin Ulcer/etiology , Skin Ulcer/microbiology , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Arm/pathology , Child , Debridement , Diagnosis, Differential , Humans , Male , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Prognosis , Skin Ulcer/diagnosis , Skin Ulcer/drug therapy
10.
Chir Main ; 24(1): 52-4, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15754714

ABSTRACT

A case of septic carpal monoarthritis due to Mycobacterium kansasii developing 16 months after accidental inoculation in a healthy laboratory technician is reported. No predisposing factor such as immunosuppression, preexisting degenerative, inflammatory arthritis or cortisone injection was present. Treatment with antituberculous oral medication alone resulted in resolution of the disease. Synovectomy was unnecessary. Ten years after the initial causative event, the patient remains free of symptoms.


Subject(s)
Arthritis, Infectious/drug therapy , Arthritis, Infectious/etiology , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium kansasii/pathogenicity , Osteoarthritis/drug therapy , Osteoarthritis/etiology , Adult , Antitubercular Agents/therapeutic use , Arthritis, Infectious/pathology , Female , Humans , Medical Laboratory Personnel , Metacarpus/pathology , Mycobacterium Infections, Nontuberculous/etiology , Mycobacterium Infections, Nontuberculous/pathology , Needlestick Injuries , Osteoarthritis/pathology , Treatment Outcome
11.
Chir Main ; 23(5): 224-8, 2004 Oct.
Article in French | MEDLINE | ID: mdl-15573875

ABSTRACT

INTRODUCTION: We have reviewed the short-term results of the ARPE arthroplasty of the first carpometacarpal joint for osteoarthritis of the thumb. MATERIAL AND METHODS: One hundred and eighteen patients have been operated on in our department between June 1999 and June 2003, by the same surgeon. Sixty-three of these patients had been followed for a minimum of six months and were included in this retrospective study. We have evaluated functional results as pain, key-pinch, mobility and patient satisfaction. The occurrence of complications was investigated. RESULTS: The results of this procedure were found to be excellent for pain, mobility and strength. Recovery was judged fast and patient satisfaction was high. The most frequent complication was implant luxation in six cases. Implant loosening was seen in three. DISCUSSION: Functional results of this type of arthroplasty are excellent. We consider it to be superior to trapeziectomy for recovery (rehabilitation is unnecessary) and strength. Most common complications have a relatively simple surgical solution. Trapeziectomy remains possible thanks to a minimal shortening of the metacarpal bone. CONCLUSION: The ARPE arthroplasty can be considered as a good surgical option for treatment of thumb osteoarthritis. A longer follow up is necessary to predict the long-term behaviour of the prosthesis.


Subject(s)
Arthroplasty, Replacement/instrumentation , Joint Prosthesis , Metacarpophalangeal Joint/surgery , Osteoarthritis/surgery , Thumb/surgery , Adult , Aged , Arthroplasty, Replacement/methods , Female , Humans , Male , Middle Aged , Prosthesis Design , Prosthesis Failure , Treatment Outcome
13.
Chir Main ; 23(1): 52-4, 2004 Feb.
Article in English | MEDLINE | ID: mdl-15071969

ABSTRACT

An unusual fracture of the scaphoid occurred in an otherwise healthy young badminton player, caused by a violent movement of extension/flexion of the wrist while performing a smash. There was no direct blow or fall on the wrist, nor history of wrist pain prior to the fracture. No underlying pathology was identified. Conservative treatment failed and surgical stabilization was required to achieve bone union. The diagnosis of stress fracture was suggested. The characteristics of these uncommon fractures are reviewed.


Subject(s)
Fractures, Stress/etiology , Racquet Sports/injuries , Scaphoid Bone/injuries , Adult , Humans , Male
14.
Chir Main ; 21(3): 182-7, 2002 May.
Article in English | MEDLINE | ID: mdl-12116830

ABSTRACT

INTRODUCTION: Regional anesthesia of a single finger is commonly achieved by the traditional ring block. The major drawback of this technique is the need for at least two painful injections in the digit. Single injection techniques have been described. A comparison of their results could help health professionals select the most appropriate technique. MATERIAL AND METHODS: A prospective randomized study was designed to compare three techniques in term of patient tolerance, distribution of anesthesia and efficiency: the modified transthecal digital block, the subcutaneous digital block and a combination of the two. Digits were randomized in three groups (n = 30). Blocks were performed by a single investigator. A visual analogic scale was used to evaluate pain associated with the injection. Prick-testing was used to evaluate anesthesia at the volar and dorsal aspects of the phalanxes. Statistical analysis of the results was performed. RESULTS: All techniques allowed surgery to be performed without complementary injection most of the time (25/30). The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. The highest rate of full digital block was achieved with the combined technique. DISCUSSION: The least invasive of equally effective techniques should be considered as the first choice. The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a supplementary dorsal block should be used.


Subject(s)
Anesthesia, Conduction/methods , Fingers/innervation , Nerve Block/methods , Anesthetics, Local/administration & dosage , Anesthetics, Local/pharmacology , Humans , Injections, Subcutaneous , Pain Measurement , Patient Satisfaction , Prilocaine/administration & dosage , Prilocaine/pharmacology
15.
Chir Main ; 21(6): 350-4, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12553195

ABSTRACT

INTRODUCTION: The purpose of this study was to evaluate the results of percutaneous fixation of undisplaced or minimally displaced fractures of the scaphoid using the first generation Herbert screw in terms of union, functional results and scaphoid mobility. METHODS: 30 of the 50 patients operated on in our department between 1995 and 2000 were available for evaluation by an independent observer. Wrist mobility, grip strength and key pinch were measured. Scaphoid mobility was evaluated by measuring radioscaphoid angles in flexed and extended positions on dynamic X-rays. RESULTS: The union rate was comparable to that achieved by non-operative management (90%). Resumption of professional activities was possible long before bony union because immobilization was short. Grip strength, wrist and scaphoid mobilities were comparable to the controlateral sides except for scaphoid flexion. Persistent symptoms were found in 30% of the patients despite union of their fracture. DISCUSSION: Our results demonstrate that percutaneous stabilization of undisplaced or minimally displaced fractures of the scaphoid preserves the mobility of the wrist and minimally alters the normal dynamics of the carpus. The duration of work inability is short.


Subject(s)
Bone Screws , Fracture Fixation, Internal/methods , Fractures, Closed/surgery , Scaphoid Bone/injuries , Adult , Female , Hand Strength , Humans , Male , Range of Motion, Articular , Scaphoid Bone/surgery , Treatment Outcome
16.
Chir Main ; 21(6): 366-7, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12553199

ABSTRACT

Many finger holding devices have been developed to retract digits and provide exposure during hand surgery. We describe a simple, and cheap trick to keep fingers out of the way using adhesive strips that has proven efficient and helpful.


Subject(s)
Bandages , Fingers , Hand Injuries/surgery , Orthopedic Procedures/methods , Adhesives , Humans
17.
Chir Main ; 20(4): 280-6, 2001 Aug.
Article in English | MEDLINE | ID: mdl-11582905

ABSTRACT

INTRODUCTION: Atypical mycobacteria are an uncommon cause of hand infections in immunocompetent patients. Diagnosis is often delayed, with consequent increased morbidity. Better awareness would allow earlier diagnosis and treatment. MATERIAL AND METHODS: Eight patients with atypical mycobacterial hand infections treated in our department over a 21 year period have been retrospectively identified. Their charts have been searched for the general characteristics of these infections, treatment and outcome. Our findings have been compared to the data collected from a literature review. RESULTS: These pathogens have caused soft tissue infections in otherwise healthy patients. Clinical signs were those of chronic finger or wrist synovitis or skin granulomas. Carpal tunnel syndrome was a common finding. Diagnosis relied on surgical biopsy. Germ identification required specific incubation temperature and media. Antibiotics and synovectomy have been the mainstay of therapy. DISCUSSION: In a patient with achronic, relapsing, superficial or deep skin infection or tenosynovitis, aquatic and farm exposures are important anamnestic keys to diagnosis. Extensive synovectomy is both diagnostic and therapeutic. Specific cultures should be ordered without delay. Oral pharmacotherapy should be initiated upon clinical suspicion.


Subject(s)
Hand/microbiology , Mycobacterium Infections, Nontuberculous/pathology , Skin Diseases, Bacterial/pathology , Adult , Aged , Diagnosis, Differential , Female , Hand/pathology , Humans , Immunocompromised Host , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/drug therapy , Retrospective Studies , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/drug therapy , Synovectomy , Synovial Membrane/pathology
18.
JBR-BTR ; 84(3): 114-7, 2001 Jun.
Article in English | MEDLINE | ID: mdl-16619697

ABSTRACT

Arthrography and CT arthrogram were evaluated in the diagnosis of dorsal peripheral detachment of the triangular fibrocartilaginous complex (TFCC) in the wrist. The imaging findings and medical records of 19 patients, who underwent surgical repair of a dorsal peripheral detachment of the TFCC, were retrospectively studied. Diagnoses were based on the results of the arthrography and CT arthrogram as well as on the clinical examination. The arthrographic features assessed included abnormal filling of the tendon sheath of the extensor carpi ulnaris (ECU) and irregular contrast extravasate in the dorsal ulnar and peristyloid region. The findings on arthrography and CT arthrography were correlated with the arthroscopic results. In conclusion, the arthrographic signs seem to be reliable findings in the diagnosis of dorsal detachment of the TFCC.


Subject(s)
Arthrography/methods , Cartilage, Articular/injuries , Ligaments, Articular/injuries , Wrist Injuries/diagnostic imaging , Adult , Cartilage, Articular/diagnostic imaging , Female , Humans , Ligaments, Articular/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Supination , Tomography, X-Ray Computed
19.
Rhinology ; 36(1): 37-9, 1998 Mar.
Article in English | MEDLINE | ID: mdl-9569441

ABSTRACT

Two cases of orbital complications secondary to functional endoscopic sinus surgery are presented. One case was complicated in the immediate post-operative period with an orbital haematoma, which required urgent decompression using lateral canthotomy. The second case had presented an acute orbital haemorrhage during functional endoscopic sinus surgery, which required the same surgical procedure. These cases demonstrate that lateral canthotomy constitutes a safe and fast surgical procedure to decrease the intraorbital pressure.


Subject(s)
Endoscopy/adverse effects , Nasal Obstruction/surgery , Ophthalmologic Surgical Procedures/methods , Orbit/surgery , Retrobulbar Hemorrhage/surgery , Adult , Disease-Free Survival , Female , Humans , Intraocular Pressure , Male , Middle Aged , Nasal Obstruction/diagnosis , Reoperation , Retrobulbar Hemorrhage/etiology , Tomography, X-Ray Computed , Vision Tests
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