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Abstract: The induced membrane technique of bone reconstruction described by A.C. Masquelet is a well-known and efficient procedure for the lower limbs but is rarely used in the hand. After debridement, the technique consists first in inducing a foreign body membrane by the implantation of a cement methyl methacrylate polymer spacer and then filling the defect by cancellous bone. We report a case of induced membrane to save an infected vascularized custom made toe-to-hand transfer. The second stage was done 3months after the first. Bone healing was obtained 4months later. No specific complication was observed. Induced membrane technique seems to be another possibility for bony defects of the hand besides vascularised or non-vascularised grafts. It is essential to apply the principles of the two stages of the procedure, first respecting the foreign body membrane and second stable fixation of the graft. In sepsis, this allows a second surgical debridement without compromising the graft. Masquelet technique, simple and reproducible, seems an effective salvage procedure for bone defects of the thumb. [Copyright &y& Elsevier]

Summary: Introduction: The pedicled groin flap, well known for the hand resurfacing, has first been described by Mac Gregor in 1972. But the free groin flap is unpopular because of its short (5mm) and small artery (caliber 1,5 to 2mm) and a bulky aspect. The purpose of this study is to show its interest by weighing up the pros and cons of its advantages and of its disadvantages. Patients and methods: This study concerns 19 cases of free groin flap for posttraumatic reconstruction of limbs between 1994 and 2009. The patients including six children, were 10 males and nine females, ages from 4 to 50 years old. The size flap ranged from 4×10 to 15×25cm. We reported the indications, the wound''s size, the postoperative complications and the quality of life. Results: We observed one total necrosis and three partial necrosis. One debulking was generally required. Conclusion: The free groin flap has a lot of valuable qualities: a good vascularisation, allowing a big size flap (20×30cm), with direct closing of the donor site, in only one surgical installation, without sacrifying a muscle. The scar of the donor site is easily hidden by underwear. The flap''s skin has good quality, without hair, and the antifibrotic effect of the fat permits a good tendinous sliding. Compared to the pedicled groin flap, this free technique enables the reconstruction of the lower limbs, while upper limbs are free, without weaning time. The functional and aesthetic result of the reconstruction is good and we think that for a microsurgical team, this reliable flap should be more chosen for the posttraumatic reconstruction of limbs. [Copyright &y& Elsevier]

Summary: Salmon has described first the vascularisation of the posterior cutaneous nerve in 1936. Since, few articles have described the collaterals of the artery accompanying the posterior cutaneous nerve. The authors conducted an anatomical study on 20 cadaveric dissections with injection in order to define the collaterals of the artery. The findings reveal an artery nourished proximally by fasciocutaneous branches of the profunda perforating arteries and distally by branches from popliteal and genicular arteries. Their association is variable. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aim of this study was to assess the timing of muscle activation during the acceleration phase of topspin forehand drives in young tennis players. Synthesis: The activity of six muscles was recorded using surface electromyography during topspin forehand drives in 22 players (9–17 years). The timing of muscle activation was characterized by the onset of EMG bursts during the acceleration stage. Conclusion: The proximal-to-distal sequential muscle activity was observed for the agonist muscles while the antagonist muscles were recruited at the end of the acceleration stage. This sequential muscle activity was common to all participants whatever their abilities. [Copyright &y& Elsevier]

Abstract: Distal extremity of lower limb sustains the complications of loss of tissue: problem of coverage (cutaneous and tendon necrosis, osteoarticular infection. The whole point of the surgery is to fight against the infection by repeated debridments, against the deformations or their correction by early osteosynthesis (pins and external fixation). The coverage is very important in this treatment: either with Vacuum-Assisted Closure (VAC®) and skin graft or fasciocutaneous flap. In spite of this management, the after-effects are important although the conservative treatment is the determining factor of satisfaction. [Copyright &y& Elsevier]

Abstract: The fibular pedicled proximal vascular island flap for distal femoral bone reconstruction described for the first time by Cariou on 1996, is studied in this article with an anatomical view. This anatomical morphometric study allows to assure the surgeon that this procedure can be done and to precise the surgical technique. The autors showed that, dependent on the length of the lower limb and the level of the fibular artery origin, 10 to 19 cm of femoral bone reconstruction could be done, after 180° flap rotation. The flap can be used, the fibula separated in two parts, for inferior femoral metaphysis reconstruction or for knee joint arthrodesis. [Copyright &y& Elsevier]

Abstract: The lion''s share of articles dealing with the thumb anatomy of Plio-Pleistocene hominids has focussed on the capacity to manipulate and manufacture tools, and has largely neglected the locomotor aspects. However, in these hominids, the forelimb was still employed in locomotion. Certain of the anatomical characters classically associated with manipulation and/or fabrication of tools are already present in the Late Miocene species Orrorin tugenensis as shown by the terminal thumb phalanx BAR 1901''01. This specimen reveals crucial information suggesting that thumb morphology is not exclusively related to such tool using and manufacturing activities but reflects in a frequently bipedal creature a deeper adaptation concerning the precision grip essential for climbing and balancing, different from that of apes. [Copyright &y& Elsevier]

Abstract: We report the case of a 38-year-old woman with a necrotizing bacterial skin and soft tissue infection with muscular involvement. The clinical picture was similar to a gaseous gangrene of the right lower limb with a septic shock and multiple organ failure, without predisposing factor such as trauma, and necessitating a hip amputation. The primary site of the disease was a perforated colic adenocarcinoma with peritoneal and retroperitoneal infection. The association of necrotizing skin and soft tissue infection with muscular involvement due to Clostridium septicum to a neoplasma is classical and in front of such an infection a neoplasma should be researched. [Copyright &y& Elsevier]

Abstract: We report clinical observations and cytogenetic studies of an inherited partial trisomy 8q and partial monosomy 18p. A full trisomy 8 syndrome (Warkany syndrome) is a clinically recognized syndrome. Partial trisomy 8q has been reported sporadically in the literature with variable phenotypes. Partial monosomy 18p, deletion of the short arm of chromosome 18, is also a well-recognized syndrome. This is the first report to the best of our knowledge of partial trisomy for distal 8q and partial monosomy for distal 18p occurring together in a patient. [Copyright &y& Elsevier]

Objective. – To translate in Arabic and validate the Lequesne index for use in Tunisian.Background. – No instrument wording in Arabic language and validated in an Arab population to measure lower limb functional disability caused by OA.Design. – Arab translation was obtained using the “forward translation/backward translation” method. Adaptations were made after a pilot study. Patients with symptomatic knee osteoarthritis fulfilling the revised criteria of the American College of Rheumatology were included. Impairment outcome measures (VAS pain; knee mobility; Kellgren’s radiological score); disability (the maximum distance walked; WOMAC index) and Beck depression scale were recorded. Inter rater reliability was assessed using the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using the Spearman rank correlation coefficient (convergent and divergent validities) and a factor analysis was performed. Internal consistency of each factor was assessed by Crohnbach alpha coefficient.Results. – One hundred and three patients were included. All questions were acceptable and retained. Inter rater reliability was excellent with ICC = 0.91. The Bland and Altman method showed distribution of differences homogenous and no systematic trend. Expected divergent validity and convergent validity were observed, suggested good construct validity. Two main factors were extracted by factor analysis of the Lequesne, and explained more than 55% of the cumulative variance, the first factor represents disability and the second represents pain and stiffness. Crohnbach alpha coefficient was, respectively, 0.68 for factor 1 and 0.54 for factor 2.In conclusion, we translated and adapted the Lequesne index into Arabic to suit Tunisian people. Translated questionnaire is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it can suit other Arab populations especially North Africans. Further studies are needed to confirm such hypothesis. [Copyright &y& Elsevier]

We report our experience of plastic surgery of the face, limbs and burns in Mongolia. This country is huge, as three times as France and has got 2,4 millions of inhabitants of whom almost one million lives in the capital city Oulan-Baator, where sanitary and weather conditions are very tough for a large part of the population.The main observed and treated pathologies were sequellae of nerves and vessels lacerations, sequellae of complex hand injuries, sequellae of leg traumas, face, neck and limb burns, lips and palate clefts and pressure shores.The training of Mongol surgeons is far from good in the fields of skin coverage, digits reconstruction, treatment of nerve and vascular injuries and management of burns. Pedicled radial antebrachial, posterior interosseous, inguinal, sural, saphenous and lower limb muscular flaps were performed and taught. Microsurgery is still starting up. Thus we performed the first second toe transfer to reconstruct an amputated thumb. Some clinical cases are presented.This French–Mongolian cooperation should continue in order to match between both countries the knowledge and use of standard techniques in plastic surgery. [Copyright &y& Elsevier]

The fasciomusculocutaneous flap at the leg (FMC) include a muscle strip in the classic dissection of the fasciocutaneous flap (FC); this muscle survives only by the musculocutaneous vessels perforators. This muscle improves the trophic quality of the classic FC flap and allows him to bring easily muscle to the lower third of the leg and sole of the foot. From october 96 to january 2001, 9 posterior FMC flaps have been used in 9 men, their ages were between 22 and 61-years-old, 8 of these flaps were distally based and 1 was proximally based. The muscle strip came from the medial gastrocnemius muscle, its lengh and its width corresponded to the dimension of this muscle but the depth has never exceeded 10-12 mm. The skin defects have a diameter ranging from 7 to 10 cm and were localised in 3 cases in the sole of the foot, in 5 cases in the lower third of the leg with 1 case of tibial osteomyelitis and in 1 case in the external part of the knee. All these defects were secondary to trauma. No complications were reported with this technique. There was no vascular problems with the muscle strip: its bleeding was checked at the operating room and at 3 weeks when the pedicle was severed. All these patients were hospitalized between 4 and 5 weeks. With an average of 30 months follow-up all the defects covered were very satisfying and the case of the osteomyelitis was healed. There is no functional sequellae and the aesthetic sequellae are those of the classic FC flaps at the leg. [Copyright &y& Elsevier]

Objectives. – To determine the outcome and the place of transluminal angioplasty (ATL) in the treatment of severe limb ischaemia.Mate´rial and methods. – Seventy two legs at stage III and IV of Fontaine’s classification have been exclusively traited by endoluminal procedures. The success was valued both on the haemodynamic post-operative improvement of the run-off flow and on the clinical statut leading to the conservation at mid-term of a fonctionnal limb. Patency and survival rate had been valued by actuarial method.Re´sults. – Seventy percent of the limbs were haemodynamically improved. For the global population, a 48% clinical success rate was obtained at 6 months but 30.5% of limbs were loss. Primary patency rate was respectively 79, 71 and 68% at 6, 12 and 24 month. The quality of the run-off arteries has been the most influential factor.Conclusion. – Endoluminal treatment of chronique limb ischaemia had lead to a clinical improvement in 48% of cases. Multi-stages and distal atherosclerotic disease of this patients limits ATL indications wich results depend of run-off quality. [Copyright &y& Elsevier]

It is fundamental to model the mechanisms that take place in the human postural system. This permits to interpret and to quantify the phenomenon''s that are linked to the postural system. These patterns can be applied in fields such as the diagnosis-help (to detect vertigo, balance disorder), the choice of the therapy, or of re-education. Considering the man as an articulated robot, we could envisage the study of the postural control system with a multi-segment analysis. The mechanism we estimate uses some magnetical 3D trackers that permit to follow the motions, relative to diverse segments, in 3D. The main segments are composed by the head, the neck, the trunk and the limbs. The 3D trackers'' response is most of the time riddled with mistakes, notably due to the magnetical field distortion. After showing this distortion, we will see how to correct it, and in which extent the use of this system seems to be well adapted to the study of the postural control system in clinic. [Copyright &y& Elsevier]

Objective – To study test-retest reliability of pinch grip strength with a two-month gap in three upper limb positions. To study factors causing variability of peak force.Material and methods – Forty healthy control volunteers, sex-ratio 1, mean age 36.6 years (sd = 9.9), were separated into four groups of ten persons. The Microfet 2 dynamometer was used to measure peak force developed during pinch grip. The measurements were made in three positions: upper limb parallel to body, arm flexed at 90° and during the Roos manœuvre. Test-retest reliability was evaluated after two months. Statistical analysis used the correlation test (p=0.05).Results – Reliability proved to be excellent in all three positions and in all four groups. Dynamometer values were stable between the beginning and end of the Roos manoeuvre in this healthy population. There were no significant differences between peak force measured in the three positions and between left and right upper limbs.Discussion – The Roos manoeuvre gives a stable and reliable result in a population without thoracic outlet syndrome. Dynamometer tests are also reliable in the usual upper limb positions, in accordance with other studies.Conclusion – This dynamometric test should be useful in assessing the severity of thoracic outlet syndrome and in demonstrating the therapeutic efficacy of different treatments. [Copyright &y& Elsevier]

Abstract: The primitive neuroectodermal tumours (PNET) of soft tissues belong to the Ewing''s tumors family and affects particularly the child. The localization of the disease at the extremities is very rare within the adult population and raises the problem of differential diagnosis with others tumors of the soft tissues. We report the case of a 48-year-old patient with a localized tumor, at the level of the second right finger, of six months evolution. The biopsy showed the infiltrating nature of the tumour; and the diagnosis of (PNET) was confirmed after the histological and immunohistochemical study. The extension assessment was negative and the patient had an amputation of the second and third rays of the right hand. Four years afterwards, the patient showed no recurrence or metastases. [Copyright &y& Elsevier]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The amelanotic melanoma is a rare type of malignant melanoma. The purpose of this report is to point out this aspect of melanoma, whose diagnostic delay is frequent. We describe one localisation on the penis, rare in this kind of melanoma and two cases of the extremities, more frequent localization of the amelanotic melanoma. The therapeutic issues and recommendation are similar to the classical pigmented malignant melanoma. [Copyright &y& Elsevier]

Abstract: Spindle cells hemangioendotheloma generally reaches the extremities. Only one oropharyngeal localisation was described in the literature. We report the observation of a 41 years old patient who was operated twice for this localization. The patient presented in 2005 with a third recurrence with important local extension contraindicating surgical treatment. An external radiotherapy was carried out with a good local control of the lesion. In the light of this observation we will discuss physiopathology of this rare lesion and the various therapeutic options. [Copyright &y& Elsevier]

Abstract: Snakebite poisonings are frequent In Morocco, because of the delay in treatment, they can be very serious even lethal. Treatment has two components: firstly correction of the systemic hemodynamic, respiratory and haematological disturbances and secondly administration of specific antivenom. Envenomation of a limb can lead to cutaneous necrosis, compartment syndrome and even necrotising fascitis. Early diagnosis and prompt treatment is needed to prevent these complications. We report two cases of compartment syndrome of which one was combined with systemic manifestations and the other caused residual pathology in the limb. [Copyright &y& Elsevier]

Melorheostosis is a rare chronic bone disease of unknown etiology that often affects a single limb. Onset usually occurs in childhood or early adolescence. A flowing wax appearance along the surface of the bone and multiple areas of bone sclerosis produce a typical radiographic picture. We describe the first case reported in a black african, in whom an exceedingly rare feature was a bilateral distribution of the lesions. [Copyright &y& Elsevier]

Résumé: La notion de courbure est l’élément essentiel du comportement mécanique de la colonne vertébrale avec la participation de toutes les articulations du membre pelvien. Après la croissance, la morphologie de la colonne vertébrale est considérée comme équilibrée. Il existe plusieurs types de courbures qui sont propres à chaque individu. La colonne vertébrale s’organise en un trépied : colonne corporéodiscale en avant, les 2 colonnes des zygapophyses en arrière. Le disque intervertébral constitue un amortisseur et un transmetteur de forces d’une très grande laxité quand il est sain. Le nucleus pulposus se conduit comme dans un milieu hydrostatique : il répartit les forces dans toutes les directions de l’espace. Peu ou pas compressible, il traduit les forces de compression reçues de vertèbres adjacentes en forces centrifuges de distension des lamelles de l’annulus, dont la disposition et l’élasticité favorisent la dissipation. La résistance du disque articulaire aux forces agissant dans un plan frontal, ainsi qu’aux tractions verticales est considérable ; par contre, elle autorise des mouvements d’inflexion latérale modérés. Ainsi, sont conciliées stabilité et flexibilité de la colonne. Le rôle des aponévroses et des muscles intrinsèques et extrinsèques est d’approche diagnostique et thérapeutique difficile. La prise en charge thérapeutique d’une lombalgie est complexe et nécessite une analyse tridimensionnelle permise par les moyens informatiques modernes. [ABSTRACT FROM AUTHOR]

Summary: Methods for lymphatic imaging are numerous and can be roughly classified as anatomic or functional studies. Direct or indirect lymphographies provide useful informations in case of lymphostasis. Contrast lymphangiography is the only anatomical method giving precise informations either on lymphatic ducts or lymph nodes. Nevertheless this invasive method is no more indicated in cases of limb edemas. Indirect lymphographies study the spontaneous lymphatic drainage of inert particles injected into the dermis. The blue dye test is the most simple and the oldest indirect lymphography used in the positive diagnosis of a lymphostasis. It has been replaced with the indirect radionuclide lymphography which give more reliable informations. Fluorescence microlymphangiography is an atraumatic method which permits the visualization of skin lymphatics. Indirect lymphangiography with contrast medium give reliable informations on the status of the initial lymphatics and is the best imaging method to differenciate between lipedema and lymphedema. Indirect radionuclide lymphoscintigraphy is a safe, non invasive and physiologiocal method for the assessment of the limb lymphatic system used for morphological studies and objective measurement of the peripheral lymphatic function necessary to assess the lymphatic variation under therapy (decongestive physiotherapy, surgery, drugs). [Copyright &y& Elsevier]

Summary: In patients with lymphedema, the volume of the affected limb is rarely measured in routine practice or may only be appreciated by a method giving a result in centimetres, an incorrect unit for volume quantification. Measurement of limb volume allows early diagnosis of lymphedema, long before the clinical signsappear. Two methods exhibit excellent reproducibility: the water displacement method which is the gold standard, with an accuracy of 0.7% and reproducibility of 1.3%, and the perimetric method, which has a good intraclass coefficient of correlation of 0.99. The water displacement method is the gold standard because it is the only one that gives the exact volume of the limb, including its extremity (hand or foot), but it has the drawback of requiring water. The perimetric method has two drawbacks: it does not include the hand or foot in the volume measure, and therefore gives an approximate volume of the affected limb, and it requires a computer to calculate the cone volumes. Taking, as an example of limb volume measurement, the case of patients operated for breast cancer, a difference between the post and pre postoperative volumes of ≤ 100 mL is reassuring, a difference > 100 and ≤ 250 mL requires regular surveillance, and a difference exceeding 250 mL is an indication for drainage and elastic compression. When the preoperative limb volume is unknown, the volume of the ipsilateral limb can be used. [Copyright &y& Elsevier]