[Ballistic hand trauma]. / Traumatismes des mains par agents balistiques.

46 victims of projectile accidents or explosions were treated over a 5 years period between 1984 and 1989. 3 categories were distinguished: injuries due to a single projectile (12 cases), only inducing serious bone damage and, apart from 3 immediate amputations, the final result was satisfactory. Injuries due to multiple scattered projectiles (11 cases), less severe in terms of the initial lesions, not requiring any amputations, with good results in 8 cases. Explosion injuries (23 cases) in which the effect of the explosion induced considerable initial lesions leading to one hand amputation and 33 finger amputations; the association of skeletal and soft tissue lesions raises the problem of excision and primary cover, requiring large flaps. The course is long and 8 out of 26 hands had serious sequelae, while the reconstruction of an elementary pinch can be considered to be an acceptable result in the other cases.

[Comparative study of the effects of a local antibiotic and a local antiseptic in emergency hand surgery]. / Etude comparée des effets d'un antibiotique et d'un antiseptique locaux en chirurgie d'urgence de la main. Etude contrôlée portant sur 223 patients.

An open randomised comparative study was conducted in patients presenting with a hand injury requiring a surgical operation, in order to compare the efficacy of topical application of rifamycin SV with that of iodinated polyvidone dermal solution, in terms of the quality and rate of healing evaluated by the clinician, 268 patients were included in the study and 223 of them participated in the analysis of the results. Analysis of the results demonstrated the following conclusions: signs of infection developed in 8 patients in the rifamycin SV group (7%) and in 20 patients in the iodinated polyvidone group (18.5%). This difference was significant (p = 0.011) in favour of rifamycin SV. The rate of healing was considered to be rapid in 10% of patients in the rifamycin SV group and in 4% of patients in the iodinated polyvidone group. It was considered to be slow in 14% of the subjects in the rifamycin SV group and in 21% of those in the iodinated polyvidone group. This difference was also significant in favour of the rifamycin SV group (p = 0.038). In terms of local tolerance, 32 patients equally distributed between the two treatment groups developed signs of cutaneous intolerance.

[Acute ischemia of the fingers]. / Ischémie aiguë des doigts.

Chronic vascular insufficiency of the fingers may turn in acute ischemia with cold. The authors report three cases. The first patient showed on his forefinger a distal thrombosis of the ulnar collateral artery and a very thin radial collateral artery. The second patient has interruption of both indicis collateral arteries. The third patient presented an ischemic fifth finger secondary to a distal ulnar artery stenosis. All of the patients complained of pain, numbness, cyanosis or necrosis of the tip aggravated by cold. Laboratory and vascular investigations included digital Allen Test, plethysmography, Doppler examination, axillary block and angiography. The cause may be local and easily cured by surgery, but sometimes the vasospastic component is predominant. If stopping smoking, vasodilators and calcium-inhibitors are ineffective, Flatt has proposed distal digital artery sympathectomy.

[Expansion of the facial integument in children]. / Expansion du tégument facial chez l'enfant.

In the light of four clinical cases of paediatric facial reconstruction, the authors discuss the advantages and indications of the cutaneous expansion technique which can be combined with other plastic surgery procedures to obtain an abundant skin with ideal texture and sensitivity and minimal scars. Operations for cicatricial alopecia, very extensive forehead naevus, preauricular tumour and nasal mutilation are described.

Conversion to arthroplasty from proximal interphalangeal joint arthrodesis.

Fifteen patients, interested by the functional results of certain arthroplasties and discouraged by those of their arthrodesis, agreed to undergo disarthrodesis. This operation was performed by arthroplasty with Swanson implant under the following 4 conditions: excellent skin cover, an intact flexor system, articular fusion in good position with preservation of the normal length and axis of the finger, the understanding by the patient that an arthroplasty does not mean normal range of movement but, at best, recovery of a limited but functional, stable and pain-free range of movement. 12 cases operated between 1971 and 1984 have been followed for a mean of 39 postoperative months. The mean gain of active movement from a fused joint was 56.8. The postoperative course was always uneventful in these particularly motivated patients and 11 out of 12 were satisfied with their result.

A simplified bloodless procedure for extensive hepatectomy. Experimental study in the pig.

An original procedure of extensive bloodless hepatectomy is described in the pig. Complete vascular liver isolation with aorta clamping up to 25 min allows 60-75% bloodless hepatectomy without any portal triad dissection. Perfect hemostasis and shortening of liver ischemia is obtained with the use of a gelatin-resorcin-formaldehyde adhesive. Hemodynamic tolerance is good, and liver regeneration appears to be as fast as in minor species.