Joseph Bakhach

reverse Dorsal Digital and Metacarpal Flaps: A Review of 27 Cases

Reverse dorsal digital and metacarpal flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks of the fingers. These flaps are transposed as reverse island flaps. Dissection of the flap is easy, fast, and preserves the collateral nerve and artery to the fingertip. A series of 27 flaps is reviewed, with more than 6 months of follow-up. Skin defects in all patients were located over or beyond the proximal interphalangeal joint as far as the fingertip and were combined with bone, joint, or tendon exposure. The flaps we used were reliable, and a joint or extensor tendon reconstruction could be performed at the same time. Patients were discharged the day after surgery and allowed to mobilize the finger early. No flap necrosis was observed, and donor site morbidity was minimal; primary closure or a skin graft was used in all patients. These flaps combine the advantages of an extended skin paddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects. When conventional local flaps are inadequate, this fast and simple procedure should be considered for its reliability and low associated morbidity.

The reverse auricular flap: a new flap for nose reconstruction.

In the present article, the authors describe a new chondrocutaneous island flap from the ear helix for nose reconstruction. Anatomic studies showed that helix vascularization depends mainly on the superficial temporal vessels. The presence of vascular communications between the anterior frontal branch of the superficial temporal system and the supraorbital and supratrochlear arterial systems allows this flap to be used in a reverse vascular flow fashion. This new flap has been used successfully in seven cases for reconstructing composite defects of the nasal tip and ala. The donor-site defect is repaired with an advancement and rotation flap from the helical rim, leaving an inconspicuous scar and giving an acceptable cosmetic result of the donor area.

Extensor Digitorum Brevis Muscle Flap: New Refinements

&NA; Two original operative techniques of raising the extensor digitorum brevis muscle flap are presented. These methods allow for covering distal foot defects that are difficult to cover by other reconstructive means. In the first technique, the flap is based on an extended distal pedicle supplied by the dorsal interosseous artery of the first intermetatarsal space. In the second technique, the flap receives its vascular supply from the medial tarsal artery; this procedure may be valuable when the vascular supply of the dorsalis pedis pedicle has been disrupted. To confirm the availability of these vascular pedicles, cadaver dissections were performed and proved that the extended pedicle dissection enhances the rotation arc of the flap. Four selective clinical cases, in which the flap was successfully used, are discussed. Advantages of these techniques, in reconstructing large defects in the distal foot, are delineated. (Plast. Reconstr. Surg. 102: 103, 1998.)

Use of the eponychial flap to restore the length of a short nail: a review of 30 cases.

Background: Distal digital amputations may result in composite tissue loss, affecting both the fingertip and the nail complex. Most surgical procedures that are used for fingertip reconstruction do not restore the nail defect. Methods: The eponychial flap is a new technique where a backward plication of the nail wall is used to expose the nail root and lengthen the visible part of the nail of the amputated digit. Results: The authors describe the anatomical basis and the operative technique of this flap and also review a series of 30 eponychial flaps that were performed in 28 patients. All patients presented fingertip defects treated with volar advancement flaps. This procedure was followed by an eponychial flap that restored the length of the short fingernail. Conclusions: The eponychial flap procedure is an easy and reliable technique that is indicated in distal transverse digital amputations to lengthen the short injured nail. It can be associated with any method used for repairing the fingertip defect, thus enhancing the final cosmetic result of the digital reconstruction.

Subcutaneous Tissue Function: The Multimicrovacuolar Absorbing Sliding System in Hand and Plastic Surgery

A still unresolved issue in human physiology is the mechanism of natural organ intermobility. Nevertheless, in front of this physiological phenomenon, incorporating skin, arteries, nerves, tendons, and muscles, we have to ask new questions. But any explanation has to conform with current knowledge and technologies; it cannot rely on observations from the beginning of last century. We mean that our traditional and current universitarian knowledge at the moment is not in conformity with up-to-date observations and has to be revised.

Pourquoi avoir pensé à l'allotransplantation tendineuse en chirurgie de la main en 1989 ?Why think about tendons allotransplantation in hand surgery in 1989?

Two cases of a human vascularized allotransplant of a complete digital flexion system are reported with detailed descriptions of the dissection technique and postoperative treatment. Satisfactory functional results open new prospects for this type of transplantation surgery.

Pourquoi avoir pensé à l'allotransplantation tendineuse en chirurgie de la main en 1989 ?

Two cases of a human vascularized allotransplant of a complete digital flexion system are reported with detailed descriptions of the dissection technique and postoperative treatment. Satisfactory functional results open new prospects for this type of transplantation surgery.

Ulnar Collateral Ligament (UCL) Repair

Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. It is the result of repetitive stretching and abduction stresses of the ulnar collateral ligament and the adductor pollicis aponeurosis. Most UCL ruptures are distal. Pain at the phalangeal insertion of the UCL and joint swelling are the most common symptoms the patients with acute UCL rupture present with. To avoid the displacement of an associated undisplaced fracture, it is of utmost importance to the surgeon to obtain radiographs before applying any stress on the joint. Conservative nonoperative treatment with 4 weeks plaster immobilization of the fully extended joint is the treatment of choice for most partial or complete UCL ruptures provided that there is no interposition of the adductor pollicis aponeurosis between the extremities of the ligamentous fragments (Stener lesion), no displaced fracture, no spontaneous radiological palmar or lateral joint subluxation, no supination deformity, and no painful chronic laxity. If any of the abovementioned conditions is present, a surgical intervention is indicated.

Pronator Teres (PT) to the Extensor Carpi Radialis Brevis (ECRB) Tendon Transfer

This chapter details the surgical steps involved in tendon transfer from the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) to restore wrist extension in patient with high radial nerve palsy. Pronator teres tendon is harvested and transferred subcutaneously around the radial side of the forearm where it is attached to the ECRB tendons using a Pulvertaft weave. Indications, essential steps, postoperative care, and sample operative dictation are included.

Reverse Radial Forearm Flap

Radial forearm flap is one of the workhorse flaps in reconstructive surgery. It is a versatile flap that is used for coverage of regional defects in the upper extremity especially the hand, forearm and elbow. However, when modified and used in a reverse pedicled fashion, it is useful for hand soft tissue defects after trauma or after tumor excision.