[Evaluation of results of a series of 58 breast reconstruction after cancer]. / Evaluation des résultats d'une série de 58 reconstructions mammaires après cancer.

The evaluation of 58 breast reconstructions operated in Boucicaut Hospital demonstrated positive result. The authors review the techniques used for contralateral breast symmetrization. The policy generally adapted has been to perform two sequential operations: 1st step: implantation of a prefilled prosthesis and contralateral breast symmetrization; 2d step: reconstruction of areolo-nipple complex and refinement of contralateral breast. Radiotherapy seems to be a problem in reconstruction. A 12% recurrence rate has been quoted in this group. Tram flap has been exceptionaly used by our team, as we tend to prefer the latissimus dorsi myocutaneous flap. Very few expanders have been implanted.

[Objective evaluation of the results of interventions for breast hypertrophy]. / Evaluation objective des résultats des interventions pour hypertrophie mammaire.

It would appear to be impossible to compare completely different techniques of mammaplasty performed in very different clinical situations. However, we thought it would be useful to approach the result of mammaplasties from a more "orthopaedic" point of view. Such an approach distinguishes populations of patients with different results and in whom the postoperative assessment must take into account the result obtained, the residual scars and the final breast shape. A formula has been developed after multiple attempts: [formula: see text] This formula expresses positive factors: the quantity of glandular tissue removed (in grams), the final appearance of the scars, the appearance of the overall shape of the two reconstructed breasts and the reappearance of ptosis measured from the edges of the breast below the inframammary sulcus (in the erect position). In this way, it is possible to express these positive factors by the multiplying the scores attributed to each of the factors. For example, a resection of 150 g will be scored as 1.5 and a resection of 1,200 g will be scored as 12, i.e. the weight in grams is simply divided by 100 to give the score for weight. The scar will be scored according to an individual scale of 1 to 5. The shape will also be scored according to an individual scale of 1 to 5. The division factors include the length of the inframammary scar (segment 3); this inframammary vertical line will be included directly in the calculation. In contrast, the length of the horizontal inframammary scar will be divided by 10.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ultrasonic study of the soft tissues of the hand. II. Tumors and pseudotumors of soft tissues. Preliminary results apropos of 12 surgically treated cases]. / Exploration ultrasonographique des parties molles de la main. II. Tumeurs et pseudo-tumeurs des parties molles. Résultats préliminaires à propos de 12 cas opérés.

Thirty patients underwent a sonographic examination of the hand because of nodular masses. In 12 out of these, the surgical removal exhibited 5 benign tumors (2 giant cell tumors, 1 angioma, 1 lipoma, 1 myoma), 5 pseudo-tumors (1 granulomatous tenosynovitis, 1 nodular tendinitis, 2 sebaceous cysts, 1 synovial cyst) and 2 congenital abnormalities of the lumbrical muscles. Except the lipoma and the nodular tendinitis, all the masses were hypoechoic or anechoic. The major interest of sonography in such a disease is a precise localization of the mass and the description of its connections with the surrounding anatomical structures.

[Results of the primary repair of 28 isolated median nerve injuries in the wrist]. / Résultats de la réparation primaire de vingt-huit plaies isolées du nerf médian au poignet.

Based on the study of a homogeneous series of twenty-eight isolated median nerve injuries at the wrist, sutured as an emergency procedure, the authors determined the course and sequelae of this type of nerve lesion with no associated tendon involvement. Repair was associated with epi-perineural suture performed with an operating microscope, immobilisation in slight flexion of the wrist for three weeks and rehabilitation of sensation. 60.7% of patients obtained a good or very good results with better motor recovery than sensory recovery. Nerve contusion, loss of nerve substance with suture under tension and work accidents were factors of poor prognosis.

Bacterial flexor tenosynovitis in the hand. A series of 68 cases.

The authors report 68 cases of bacterial tenosynovitis (BT) that is the largest international series dealing with this pathology since the introduction of antibiotics. Their study stresses the connection between the quality of the final result and the stage at which the condition is treated. The speed at which the tenosynovitis becomes established depends on the mechanism of infection. One can dissociate BT by direct inoculation with violation of the tenosynovial sheath, from the BT by diffusion through an undamaged sheath. The former progress within a few hours to a few days, the latter slowly in a few days to a few weeks, with a slower onset masked by the clinical signs of the initial infection. They propose a new classification which allows the choice of proper surgical therapy taking into account the type of onset of the BT and the intraoperative findings.

[Scalariform incisions. Study of 34 cases]. / Incisions scalaires. Etude de trente-quatre cas.

The scalaire incisions were indicated in 34 hands with 58 longitudinal palmar contracture which restrict extension and usually result of deep burns. The technique was suggested by the incisions used in Dupuytren's followed by directed cicatrization and wearing dynamic extension splints for 2 months. The functional results are good and fair in 85 percent of cases. The failure usually come from important articular stiffness. The cosmetic result is most often very good especially when comparing with the disadvantage of skin graft pigmentation.

[Fatigue fractures: apropos of 8 cases]. / Les fractures de fatigue. A propos de 8 cas.

Eight cases of fatigue fracture were observed by the authors. In two patients, they presented in metatarsal bones; others were in the lower end of the tibia, in the shaft of the fibula, in the patella, at the upper end of the fibula, in the shaft to the tibia and in the neck of the femur. The main features of these fractues, which occurred in previously intact bones, are reviewed. The role of previous muscle imbalance, or metabolic disturbance, (by age or in pregnancy) is discussed. Good results were obtained by simple immobilization. Surgery may be indicated in the two situations: 1. To eliminate the possibility of a bone tumour by biopsy and, 2. For internal fixation in special sites such as the femoral neck to avoid coxa vara or when healing is very slow, as occurs particularly in the femoral shaft.

[Anesthesia and resuscitation in surgery for aseptic osteonecrosis in patients with renal transplants]. / Problèmes d'anesthésie et de réanimation dans la chirurgie de l'ostéonécrose aseptique chez le transplanté rénal. A propos de 27 cas opérés.

Aseptic osteonecrosis following renal transplantation occurs in about 20 p. 100 of cases and entails important functional consequences. 16 patients with kidney transplant and 4 patients on chronic dialysis because of previous graft rejection underwent 27 orthopaedic operations, 8 of which being hip arthroplasties. During and after the procedure the anesthesiologist had to manage with drug interaction, coagulation disorders, blood compatibility problems etc... Despite poor general condition of patients and the risk of infectious complications linked to the never interrupted immunosupressive treatment, the surgical results of our serial were good.

[Aseptic osteonecrosis in the renal transplant patient. Apropos of 27 surgically treated cases]. / L'ostéonécrose aseptique chez le transplanté rénal. A propos de 27 cas opérés.

The authors have treated 27 cases of avascular necrosis of bone in patients following renal transplantation. They have noted some specific features--early onset after transplantation, multiple localization and rapid and severe progress of the lesion. The authors discuss the pathogenesis as it relates to cortico-steroids, bone dystrophy due to renal failure and the effects of dialysis. Surgical treatment requires special care because of the poor general condition of the patient. Operations have been done on 20 hips (12 forages, 1 cup arthroplasty, 2 Moore prostheses, 5 total prostheses) and 7 knees (1 forage, 6 removal of loose bodies). Two procedures were found to be valuable at the hip--forage at a very early stage and total prosthetic replacement. The indications for operation depend on the degree of functional disability. For the knee, necrosis affected both the femoral and tibial component resulting in effusion and locking. The only useful procedure seemed to be removal of loose bodies. In every case, surgical procedures must be conducted under careful and constant medical supervision.