Autumn Meeting of the French Society for Surgery of the Hand

Abstract

T he fall meeting of the French Society for Surgery of the Hand was held in Paris, France, on Nov. 23-25, 1978. The Chairman was J. DUPARC, and the Scientific Director was J. Y. ALNOT. The first day was devoted to instructional courses, and the second and third days to the autumn congress. Treatment of acute injuries of flexor tendons. The initial symposium on treatment of acute injuries of flexor tendons was moderated by J. DUPARC (Paris), who reviewed the history and pertinent anatomy of flexor tendon injuries. Specific points of the anatomy of the fibrous and synovial sheaths and newer concepts of nutrition were elaborated upon to introduce the recent concepts of the intrinsic healing potential of tendons. Suture techniques were also reviewed. J. MICHON (Nancy) reviewed his experiences with the Kleinert technique. In his opinion, each point of the techique must be adhered to carefully for maximum results. Silastic tendons are frequently helpful in localizing the proximal tendon. He thought that many errors were due to improper postoperative dressing. G. FOUCHER (Strasbourg) also stressed the importance of postoperative management, particularly with regard to the maintenance of wrist flexion and the fashioning of an adhesive pulley with tape at the level of the distal palmar crease. RICHARD (Paris) reviewed his experiences with Kleinert's techniques and HUNTER (Philadelphia) discussed the delayed primary repair of flexor tendon injuries. The latter discussant thought that this could be safely accomplished between 18 hours and 3 weeks after injury; most of his repairs had been done within the first week. Additional damage to nutrition of the tendons did not seem to be significant if the repair was within that time. Seventy-five percent of his patients flexed to within 1.8 cm of the distal palmar crease. He also showed a series of laboratory studies in which the extrinsic blood supply of tendons was interrupted at various levels and the resulting avascular segments, and he concluded by recommending that the tourniquet could be released at the time of suture, the tendon edges examined clinically for blood supply, and the results correlated retrospectively with these observations. J. MICHON (Nancy) spoke about the treatment of complex injuries involving flexor tendons and stressed the importance of repairing vessels and establishing appropriate blood supply as an aid in tendon healing. C. L. LEQUANG (Paris) reviewed his experience with complex injuries in replantation in the upper extremity with emphasis on flexor tendons. In many of his cases, he uses early motion. The symposium was concluded by a round table discussion with the participation of all the primary speakers. Acute treatment of peripheral nerve injuries. The second symposium of the first morning, chaired by J. Y. ALNOT (Paris), concerned the acute treatment of peripheral nerve injuries. M. MANSAT (Toulouse) began by reviewing the anatomy, pathophysiology, and surgery of peripheral nerves. Surgeons are now required to base decisions on metabolic as well as anatomic factors. J. Y. ALNOT (Paris) reviewed pertinent anatomy favoring primary repair. Physiological tension and fascicular orientation can be achieved only by primary repair. Methods of suture were reviewed. A combined epiperineural repair was the author's preference. MERLE (Nancy) reviewed the results of total repair in extensive lacerations of the hand. In massively contused injuries, it often is better to delay repair because the extent of resection could be difficult to evaluate. The injury to the associated vessels takes priority. If the nerves cannot be repaired at the same time, he recommended they be sutured to the adjacent soft tissue to prevent retraction. Clinical forum. A clinical forum under the direction of R. VILAIN (Paris) ensued. Instructional films. The afternoon began with two films-one on flexor tendon grafting by R. TUBIANA (Paris), and the other on capsulectomy of the proximal interphalangeal joint by R. CURTIS (Baltimore). Post-traumatic stiffness of the fingers. Later in the afternoon R. TUBIANA (Paris) moderated a symposium on post-traumatic stiffness of the fingers. He began by reviewing the articular and extra-articular causes of stiffness. The anatomy of the collateral ligaments of the metacarpophalangeal and interphalangeal joints was