J.-C. Guimberteau

Institut Aquitain de Chirurgie de la Main

The organization and architecture of living matter has never been definitively described and fully confirmed. Intra tissue endoscopy provides novel, real-time observations of living tissues. It offers insights unavailable from traditional cadaveric studies, and provides valuable new information about the microanatomy, dynamics and organization of l...

The skin , boundary of this optimal efficiency world since it allows life through this fractal and chaotic structure, has not been really studied in its morphodynamic aspect and chiefly in its continuity with the rest of the body. The aim of this article and thanks to endoscopic observations carried on the living matter during surgeries , is to sho...

The skin , boundary of this optimal efficiency world since it allows life through this fractal and chaotic structure, has not been really studied in its morphodynamic aspect and chiefly in its continuity with the rest of the body. The aim of this article and thanks to endoscopic observations carried on the living matter during surgeries , is to sho...

The skin is often viewed as a static barrier that protects the body from the outside world. Emphasis on studying the skin's architecture and biomechanics in the context of restoring skin movement and function is often ignored. It is fundamentally important that if skin is to be modeled or developed that we do not only focus on the biology of skin b...

Introduction: In France, hand injuries are the number one cause of all accidents referred to our hospital casualty departments. Their human and economic consequences are very serious. Two thirds of these accidents arise during everyday living activities and a third of them happen at work. The specific prevention of hand injuries in each of these do...

After carrying out 215 in vivo dissections, 65 of which were video-recorded, the authors propose that the current representation of the notion of the tendon sliding is incorrect. It is suggested that tendon sliding is explained by the existence of a mechanical adaptable multimicrovacuolar and fibrillar tissue. This tissue enables complete sliding w...

Over previous decades and centuries, the difficulty encountered in the manner in which the tissue of our bodies is organised, and structured, is clearly explained by the impossibility of exploring it in detail. Since the creation of the microscope, the perception of the basic unity, which is the cell, has been essential in understanding the functio...

The progress in digital and surgical technology has enhanced the exploration and knowledge of the living matter that constitutes our corporal form. Hence, endoscopic intratissular observation of living matter during surgical interventions reveals the structuring elements that are difficult to identify with a cadaver, or tissue sample, using histolo...

Over previous decades and centuries, the difficulty encountered in the manner in which the tissue of our bodies is organised, and structured, is clearly explained by the impossibility of exploring it in detail. Since the creation of the microscope, the perception of the basic unity, which is the cell, has been essential in understanding the functio...

After carrying out 215 in vivo dissections, 65 of which were video-recorded, the authors propose that the current representation of the notion of the tendon sliding is incorrect. It is suggested that tendon sliding is explained by the existence of a mechanical adaptable multimicrovacuolar and fibrillar tissue. This tissue enables complete sliding w...

The progress in digital and surgical technology has enhanced the exploration and knowledge of the living matter that constitutes our corporal form. Hence, endoscopic intratissular observation of living matter during surgical interventions reveals the structuring elements that are difficult to identify with a cadaver, or tissue sample, using histolo...

Les principes chirurgicaux académiques en matière de reconstruction des tendons fléchisseurs des doigts ont considéré le tendon comme étant une simple courroie de transmission de force entre la structure musculaire, responsable de la création de force, et la structure articulaire mobile, transformant cette force en un mouvement. Cette notion tout à...

Over several years, the author has devised different techniques for difficult bony reconstruction in hand surgery. It is based on compound island transfers of ulnar origin, harvested from the forearm's lower third with reverses flow vascularization. Because of the variety of arterial ramifications, these transplants can consist, either of a simple...

Over several years, the author has devised different techniques for difficult bony reconstruction in hand surgery. It is based on compound island transfers of ulnar origin, harvested from the forearm's lower third with reverses flow vascularization. Because of the variety of arterial ramifications, these transplants can consist, either of a simple...

Through their personal experience, the authors want to relate the problems a surgeon has to face to make an idea accepted, either on the intellectual or the technical or the material point of view. A surgeon's everyday life, his university cursus and his psychological profile does not prepare him to a very different world, the world of administrati...

The term 'fascia' has been applied to a large number of very different tissues within the hand. These range from aligned ligamentous formations such as the longitudinal bands of the palmar fascia or Grayson's and Cleland's ligaments, to the loose packing tissues that surround all of the moving structures within the hand. In other parts of the body...

Grace to the creativity of surgeons and the introduction of new technologies, second half of the XXth century opened the era of innovations and decisive progress. At the same time, however, is born the feeling of distrust and claiming which has come with the graving and threatening juridiciarisation. The evolution of complex structures of our socie...

Through their personal experience, the authors want to relate the problems a surgeon has to face to make an idea accepted, either on the intellectual or the technical or the material point of view. A surgeon's everyday life, his university cursus and his psychological profile does not prepare him to a very different world, the world of administrati...

As the follow up article to “Introduction to the knowledge of subcutaneous sliding system in humans” published in the “Annales de chirurgie plastique” we further investigate the architecture of the skin and comment on the subcutaneous multifibrillar and microvacuolar arrangements that provide form, mobility, adaptability and resistance to force of...

As the follow up article to "Introduction to the knowledge of subcutaneous sliding system in humans" published in the "Annales de chirurgie plastique" we further investigate the architecture of the skin and comment on the subcutaneous multifibrillar and microvacuolar arrangements that provide form, mobility, adaptability and resistance to force of...

After carrying out 215 in-vivo dissections, 65 of which were video-recorded, the authors propose that the current representation of the notion of the tendon sliding is incorrect. It is suggested that tendon sliding is explained by the existence of a mechanical adaptable multimicrovacuolar and fibrillar tissue. This tissue enables complete sliding w...

The reconstruction of digital pulp defects is still a challenge in hand surgery. Several reconstructive techniques are available, but in some cases, their advancement capacities are not sufficient for the flap to cover the whole defect. The Gigogne flap is a new, very simple and safe technique. It consists of harvesting two cutaneous flaps successi...

This paper reports our experience with temporary ectopic digital implantation. Four patients suffered 12 digital amputations with large defect over the proximal stumps. Only 8 digits were suitable for microsurgical salvage but the local conditions made direct replantation impossible. In our first patient, the two digits were ectopically implanted o...

The mobility of our body structures is so intrinsic and natural to us that we tend to take it for granted. The very fact of being able to pinch your skin and lift it, then let it go and see it return to its initial shape and texture in just a few seconds may seem banal enough until you begin to think of all the elements involved. The same is true w...

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 fr...

Reconstruction surgery requires imagination, inventiveness, and creation-a quest that entails overcoming obstacles never before encountered. Over the past 25 years, with the advent in microsurgery of free revascularized transfers, it was believed that this fundamental breakthrough would be sufficient to resolve difficulties of whatever nature, and...

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.

Microsurgery and human allotransplantation progress as well as the improvement of immunosuppressive drugs actually allow the development of the composite tissue allotransplantation. One of the latest challenges in plastic surgery is to restore the anatomic and functional structures using similar tissues. Composite tissue allotransplantation will pr...

The cryopreservation of cells and human tissues has generated a great interest from the scientific community since 1949 when the cryoprotective activity of glycerol was discovered. For a homogeneous cellular group or a one-layer cellular tissue it is easy to define the optimal technique conditions of its cryopreservation (cryoprotective agents, spe...

The cryopreservation of cells and human tissues has generated a great interest from the scientific community since 1949 when the cryoprotective activity of glycerol was discovered. For a homogeneous cellular group or a one-layer cellular tissue it is easy to define the optimal technique conditions of its cryopreservation (cryoprotective agents, spe...

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.

The authors present the results of their surgical experience based on an original approach in secondary reconstructing 71 flexor tendons of the hand. For 20 years, they have been using vascularized tendon transfers either islanded or as free transfers. Their techniques are based on extensive knowledge of the sliding mechanisms involved around the f...

Décrit par Lovie en 1984 en tant que transfert libre microchirurgical, c’est ce même auteur qui en 1988 le propose en transfert pédiculé en îlot rétrograde. Le lambeau antébrachial ulnaire, comme son homologue radial, appartient aux lambeaux á vascularisation septale.

At the end of the seventy, we saw the reconstructive microsurgery developed to such an extent that it became a new and an independent surgical specialty. The development of the microsurgical instrumentation and the description of the surgical anatomy allowed the application of this technology to the most complex plastic reconstructions and particul...

At the end of the seventieth, we saw the reconstructive microsurgery developed to such an extent that it became a new and an independent surgical specialty. The development of the microsurgical instrumentation and the description of the surgical anatomy allowed the application of this technology to the most complex plastic reconstructions and parti...

The authors report a new cutaneous flap harvested from the dorsal and distal quarter of the forearm: the dorsoradial flap. The vascularisation type of the cutaneous paddle belongs this flap to the anterograde and axial family flaps. The anatomical study carried out on thirty six fresh cadaver upper arms showed a constant and a consistent cutaneous...

Les auteurs décrivent une technique originale de prise en charge chirurgicale de la ténosynovite de De Quervain. Cette ténosynovite correspond à un conflit d'ordre mécanique entre la poulie styloradiale et le tendon de l'abductor pollicis longus, de l'extensor pollicis brevis ou les deux. Le traitement chirurgical classique comprend des risques de...

The authors report a new cutaneous flap harvested from the dorsal and distal quarter of the forearm: the dorsoradial flap. The vascularisation type of the cutaneous paddle belongs this flap to the anterograde and axial family flaps. The anatomical study carried out on thrirty six fresh cadaver upper arms showed a constant and a consistant cutaneous...

Les auteurs décrivent une technique originale de plastie d'expansion des poulies ostéofibreuses du tunnel digital (A2 et A4). Il ne s'agit pas d'une procédure opératoire de reconstruction des poulies annulaires, mais d'une plastie d'agrandissement du périmètre de la poulie dont la structure anatomique est totalement respectée. La réparation primiti...

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. 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 vis...

The mobility of our body structures is so intrinsic and natural to us that we tend to take it for granted. The very fact of being able to pinch your skin and lift it, then let it go and see it return to its initial shape and texture in just a few seconds may seem banal enough until you begin to think of all the elements involved. The same is true w...

We present two clinical cases with complete amputation of multiple digits that were salvaged after having been successfully implanted on ectopic sites. The first case concerns a 73-year-old patient, who suffered a severe crush injury of his right hand that resulted in amputation of all four long fingers and an extensive tissue loss of the palm and...

Deux cas cliniques de revascularisation ectopique temporaire pour sauvetage d'amputations complètes de six doigts longs sont exposés. Dans le premier cas où deux doigts longs amputés sur quatre ont été récupérés, le site d'implantation ectopique sélectionné est la face dorsale du pied avec l'artère dorsale du premier espace intermétatarsien et la v...

Tissue allotransplantation is defined by the transfer of tissues harvested from a cadaveric donor (in a brain dead condition) and revascularized to a recipient subject. This is based on the mastery of microsurgical techniques and on the induction of a therapeutic immunosuppression for the recipient. The first allografts (flexor tendon systems, knee...

Le but de ce travail est d’approcher les mécanismes qui assurent le drainage du sang veineux à contre-courant dans les lambeaux cutanés en îlot rétrograde. Un travail expérimental est mené sur douze lapins. Le modèle expérimental retenu est le lambeau cutané fémoral superficiel. Sur chaque lapin, deux lambeaux fémoraux superficiels sont levés : un...

Les auteurs présentent le résultat de leurs travaux de recherche sur le glissement tendineux après des années de dissections chirurgicales, sur des modèles animaux, et d’observations microscopiques. Ils ont élaboré un mode de fonctionnement du glissement tendineux basé sur la notion de microvacuoles et ont mis au point un modèle en 3D qui permet de...

Les auteurs décrivent un nouveau lambeau cutané prélevé sur le bord dorsoradial du poignet pour le traitement des pertes de substance dorsale du pouce et de la main. Un travail anatomique, effectué sur seize mains, met en évidence la présence d’une branche constante de l’artère radiale, à destinée cutanée, au niveau de la base de la première commis...

Les arthrodèses des 4 coins ne permettent pas d’obtenir des secteurs de mobilité satisfaisants, alors que les résections de la première rangée pêchent par le caractère aléatoire des résultats, même si la tête du capitatum est parfaite, ceci étant sans doute lié à l’incongruence des surfaces mises en contact. Les auteurs rapportent une série de leur...

Le principal écueil technique des transferts libres microchirurgicaux, lié au développement récent d’un grand choix de site donneur, est la réalisation de sutures terminoterminales artérielles ou veineuses, de vaisseaux de diamètre incongruent avec des ratios de 2/1 à 3/1. Les auteurs présentent une nouvelle technique : la plastie vasculaire en « V...

Over several years, the authors have devised a technique for compound island transplants of ulnar origin, harvested from the forearm's lower third, with reverse flow vascularization. Because of the variety of arterial ramifications, these transplants can consist: either of a simple cutaneous, superficial flexor tendon or ulnar fragment transplant,...

Hand surgeons have long sought ways of avoiding adhesions in flexor tendon repair. We report a new concept in tendon surgery--the use of flexor tendons with perfect mesotendon blood supply and an inherent gliding mechanism composed of the paratendon and the common carpal sheath to minimize adhesions during tendon healing. This technique, inspired b...

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.

Eight patients who had a recurrent pseudarthrosis of the carpal scaphoid were treated by a bone graft from the ulna, vascularized by an ulnar-artery pedicle. The graft was taken from the medial aspect of the distal third of the ulna and inserted into the prepared scaphoid. This technique is advocated only for complex recalcitrant non-union. All of...

Hand surgeons have long sought ways of avoiding adhesions in tendon repairs. The authors report on a new tendon transfer technique which is inspired by the flap based on the ulnar artery and the flexor digitorum sublimis and which ensures perfect vascularisation, good mobility and a favorable environment for suturing.

The authors discuss their experience with the ulnar artery forearm island flap in 54 cases of hand surgery. They discuss its advantages over the radial island forearm flap and examine further technical possibilities in hand reconstruction, such as the compound flap. Although these reconstructive techniques do not have any sequelae, they involve the...

Anatomical data from 20 laboratory dissections are employed to describe a composite flap associating skin, the latissimus dorsi muscle, and ribs, important anastomoses existing between the intercostal and inferior scapula vascular systems. Two cases were treated by single-stage extensive reconstruction of the mandibular region employing this osteom...

We describe the anatomy of the vastus lateralis musculocutaneous flap, and propose its use in the treatment of trochanteric pressure sores. This new technique is simple and reliable. A good padding is given to the recipient site in this particularly mobile and exposed area; the donor site is closed primarily. Indications depend on the possibilities...

An anatomical study carried out on 30 fresh cadavers, using selective injections and strict operative procedure, demonstrates the reliability of the thoracodorsal axillary flap centered on the subscapular trunk, despite the possibility of a musculocutaneous transplant when no direct cutaneous artery is present (25% of all cases). The aim of this st...

Une étude anatomique portant sur 30 cadavres frais, utilisant des injections sélectives et un protocole opératoire rigoureux, démontre la fiabilité du lambeau axillaire thoracodorsal axé sur le pédicule scapulaire inférieur, malgré la possibilité de transplant musculo-cutané lorsqu'il n'existe pas d'artère cutanée directe (25% des cas). Cette analy...