[Malingue's procedure for digital retraction in XXXX --principle, modelling and clinical evaluation].

@entity1 @entity6866 @entity2074 @entity1159 @entity272 @entity1211
INTRODUCTION: Malingue's procedure is a modified Z-plasty for the treatment of digital retraction in @entity2074 . Geometrical modelling was used to determine the theoretical efficacy of the technique, and the clinical value of the method was assessed with a follow-up of 23 @entity1 over at least two years. MATERIAL AND METHODS: Unlike Z-plasty, in which the skin flaps transposed are triangular, the Malingue plasty uses trapezoidal flaps. The direct longitudinal approach is used for the cords and the incision lines cut obliquely across the flexion folds. Euclidean geometry allows calculation of the average theoretical gain with a 45 plasty for a finger of width a, the initial surface being given by S1=a     2, and the surface after plasty by S2=a  (3/4 [   2+1]). A continuous, homogeneous, retrospective series of 27 @entity1 operated by the same surgeon for @entity2074 with @entity1159 was reviewed by a neutral observer. The technique, which combined open-palm fasciectomy with the Malingue plasty, reduced the loss of skin by extending the finger after excising the cords. The plasty was adapted to cover various @entity272 and degrees of @entity1159 . RESULTS: The Malingue procedure was performed as an outpatient procedure in 23 cases. The average theoretical gain of the skin surface was 46%. The results were evaluated immediately after surgery and over a mean follow-up of 31 months. There were ten cases for a first operation, ten with a first recurrence, and seven with a second recurrence. The operated fingers healed within three weeks with no skin distress or dehiscence. The only surgical complication involved a sectioned collateral radial nerve of the ring finger in a recurrence of @entity2074 ; a @entity1211 was used to re-establish the continuity of the nerve. Midterm complications included @entity6866 in one @entity1 , recurrence of contracture in three @entity1 , and benign lateral hypoesthesia of the first phalanx in two @entity1 . The mean Tubiana score, which fell from 4.0 to 0.18 immediately after surgery, was 0.67 at the last follow-up, with an overall @entity1 satisfaction index of 95%. CONCLUSION: The Malingue plasty follows a strict but easily applicable protocol. Avoiding the use of skin grafts or flaps, the technique offers satisfactory treatment in most cases of @entity2074 .
