[New emergency hand surgery (author's transl)]

Injured hands may now be divided into two categories: those in which revascularisation by suture or bypass is necessary as an acute emergency and those in which classical reparative surgery suffices. As far as the first category is concerned, those who first see such patients should undertake the vascular repair but also all the others, if this is possible and desirable, or refer the injured individuals to a specialised centre. The prodigious development of microsurgery and its teaching to hand surgeons should soon make it possible for all injured patients to derive full benefit from this revolution. However, the indications must be perfectly defined in order to avoid the creation of handicapped patients and useless increase in surgical expenditure.

[Complex hand injuries. Therapeutic management (author's transl)]

Defined by severe injuries of several digital structures and by lesions of several axes, complex hand injuries raise numerous problems of management. The activity of the unit "S.O.S. Hand-Reimplantation" of the Boucicaut Hospital petmitted us to determine the various clinical and socio-professional aspects. In the first part of this article, a statistical study permitted us to define the classes, types and prognosis. In the second part, the repair of each digital structure is considered (skin, bone, joint, extensors, flexors, nerves, vessels) in the light of a complex hand injury. The role of the covering skin in the quality of the results seems very important. The long-term results, their socio-professional consequences, thus permit one to draw up a therapeutic management which aims to repair the maximum number of lesions during the first stage of the operation. The interest of microsurgical repairs of the vessels and nerves requires operation of these complex hand injuries as an emergency, which requires appropriate surgical facilities.

[Paronychia, the general practitioner, the surgeon and antibiotics (author's transl)]

Antibiotic therapy for paronychia has seen its day. It is indicated only rarely and justified only when on the day following infection or during the next few days there are signs of regional or systemic spread. The surgical treatment of infections of the hand is not difficult but should be known, if not learned. A paronychia which has been opened but not cured should be reoperated upon rapidly. An "old" paronychia is a major catastrophe: small fistula, great damage. No surgical quarter for evil organisms!

[Anatomopathological aspects and treatment of sternitis and sternochondritis after cardiac surgery]

The authors report their experience of the treatment of sternitis on a surgical unit. They analyse here 23 case records out of 31 cases of sternitis treated on their unit. Out of these 23, there were 3 deaths (13 p. 100) and 16 cures (69,5 p. 100) with an average follow up of 20 months. The solutions adopted, including extremely wide exposure and, in some cases, removal of infected bone, are justified by the fact that these patients were admitted from other surgical units. The diagnosis was facilitated by the fact this unit includes a clinical bacteriology research unit. The authors make no apologies for using very classical surgical methods and attempt to demonstrate that these extreme cases require radical surgery. Their original contribution consists of the rational use of antibiotics, but the surgical solution is pre-eminent.