Tenorrhaphy and tendinous venous envelope (TVE). A morphofunctional study in 24 beagles dogs.

A morphofunctional study was undertaken in 24 Beagle dogs subjected to a a tenorrhaphy, in order to evaluate the results obtained with 3 different surgical procedures (16 hands each)--"traditional" (TRAD); the "tendinous venous envelope" (TVE), and the "simulated procedure" (SHAM). The surgical tissue (n = 48) was the extensor digitorum communis muscle of the hand (forepaw) bilaterally. For TRAD procedure, the Bunnell suture technique was applied. For the TVE procedure, the tenorrhaphy site was wrapped in a segment of autologous femoral vein and for the SHAM procedure, the tendon was exposed over 3 cm without sectioning it and the wound was closed. In each case, the limb was immobilised for 21 days in a cast. Functional data (288 X-rays) was obtained on angle variations of the radio-carpal joint in 2 different positions--passive (physiological), and forced (with an additional weight of 150 g). For each position, the angle variation obtained for each one of the surgical procedures were compared at 3 different times: day zero (surgical intervention), day 21 (cast removal), and day 35 (surgical tissue removal). Morphological data (144 sections) was obtained by analyzing the surgical tissue (tendinous fibrosis; fusion of the tendon clusters with the epimysium and the neighboring tissues; synovitis and the virtual space between the tendon and the neosheath). Tests of variance analysis by posts (critical H = 5.99), showed that the TVE procedure produced better results as compared to TRAD (SHAM approximately equal to TVE > TRAD) on day 21 (H = 22.58) as well as on day 35 (H = 8.08).

[Use of a vein segment in peripheral nerve repair]. / Utilisation d'un segment veineux dans la réparation des nerfs périphériques.

The authors describe a new technique of nerve repair based on the utilisation of a venous sleeve to isolate and to contain the severed nerve during the period of cicatrisation. The histological pattern of the venous wall and its reaction to the regenerated nerve have been studied. Electrophysiological techniques, confirmed by histological studies, have demonstrated the good quality of the anastomosis. The utilisation of a venous sleeve allows for nerve repair without synthetic suture material. The dimensions of anastomotic neuroma are reduced, and are smaller than in other techniques of suture. The possibility of isolation of neuroma by the vein, even in the case of terminal neuroma, is equally worth consideration.

[Perforating plantar ulcer. Interfascicular neurolysis of the posterior tibial nerve]. / Le mal perforant plantaire. Neurolyse interfasciculaire du nerf tibial postérieur.

The authors report the case of a 45-year-old man with perforant ulceration of the foot. The rapid evolution of the cutaneous and bone lesions (three years) necessitated a bilateral intermetacarpo-phalangeal amputation. After conventional therapy, a large necrotic zone remained on the sole of the left foot as well as hyperkeratosis of the right foot. Following Bourrel's protocol for the treatment of leprosy, the authors proposed a posterior tibial nerve neurography, which confirmed the compression of the nerve in the tarsal tunnel. In addition, histological examination of the nerve branches of the sole of the foot showed fibrous thickening of the nerve, endoneural invasion by fibroblasts, and loss of myelin. An interfascicular neurolysis of the posterior tibial nerve at the level of the tarsal tunnel together with a periarterial sympathectomy on both sides, led to rapid recovery. At the same operation, a skin graft was used to cover the skin defect with excellent results in ten days. Ten months later healing remains complete.

[The thoracodorsal skin flap. Anatomy and clinical applications (author's transl)]. / Le lambeau thoraco-dorsal. Anatomie et applications cliniques.

The authors remind of the interest of the thoracodorsal flap among the free flaps and of the armpit as donor site. Two vast reliable and trustworthy skin flaps, with varying thickness, can fairly easily be taken at this level: - the first one, based on the cutaneous branch of the thoracodorsal artery, is a flat skin flap essentially cutaneous, specially convenient for the face because of its tissue colour, the thinness of the skin and its having no hair; - the second one, centered on the thoracodorsal muscle ending or artery of the latissimus dorsi muscle, allows to cut off a musculocutaneous flap that can take away, if necessary, the quasi-totality of the latissimus dorsi muscle. They describe the anatomical observations on twenty armpits dissected on cadavers and underline length, size and constancy of these vascular pedicles. They present three clinical applications which are representative of the most favorable indications of the thoracodorsal flap.