[Increased risk of bleeding during abdominal dermolipectomies in men: Myth or reality?]

INTRODUCTION

Abdominoplasty is the most frequently performed procedure for the treatment of weight loss sequelaes. It carries risks of complications, especially in patients with multiple metabolic comorbidities. It is commonly accepted that the male population develops more postoperative complications, particularly haemorrhage, but there are very few studies showing this excessive morbidity. The aim of this study was to determine the increased risk of bleeding after anterior and circular abdominoplasty in men by comparing two series of 105 male and female patients.

MATERIALS AND METHODS

This is a retrospective, single-center study including 105 male subjects undergoing simple or circular abdominoplasty between 2013 and 2022. The control group was composed of 105 women screened on the same terms. The data collection focused on different pre-, intra-, and postoperative variables, with the occurrence of a hematoma or the need for a transfusion during follow-up as the primary outcome. The analysis was performed according to a univariate and multivariate models.

RESULTS

The rate of hematoma or transfusion, seroma, infection, amount of blood loss, and length of hospital stay were significantly greater in the male group. Multivariate analysis confirmed the independence of gender on the risk of developing a hematoma or requiring a transfusion.

CONCLUSION

This study shows the excess morbidity in men, particularly haemorrhage, after abdominoplasty. This underlines the importance of a rigorous haemostasis and follow-up in this at risk population.

[Complications Following Treatment for Excessive Axillary Sweating With Microwaves: A Case Report]

Excessive axillary sweating is a frequent reason for seeking consultation in aesthetic medicine. Botulic toxin therapies have been used for years for this condition. A microwave-based treatment (MiraDry®) has been used in France since 2011. We present the case of a patient who developed complications following such a treatment for excessive axillary sweating, namely dermal detachment, subcutaneous collections, dermal thickening, retractile scars responsible for pain and limitation of axillary amplitudes. These complications mimic the natural evolution of deep axillary burns. In this paper, we propose a management method for patients with this type of complication.

[Diagnostic pitfall: Early arising, multiple and recurrent Marjolin's ulcer. About 8 patients (16 tumors) and literature review]

INTRODUCTION

Marjolin's ulcer (MU) is a large entity representing skin cancers resulting from the transformation of chronic wounds of a heterogeneous nature. Burn scars are the most at risk of degeneration, in particular because there are the sites of important skin tension. Atypical forms are not uncommon. The objective of this study is to present these exceptions which are underestimated.

MATERIALS AND METHODS

All patients with UM in our centre between January 2011 and February 2019 have been included permitting to report the initial pathology, the location, the latency time, the histology and the management carried out.

RESULTS

Eight patients were treated in our center for MU, they developed 16 skin cancers. Fourteen were squamous cell carcinomas (SCC). The shortest latency period was 2 months. The youngest patient was 22 years old when she was diagnosed with MU. Three patients had at least 2 synchronous SCC. One patient had a recurrence after a split-thickness skin grafting on artificial dermis and 2 patients had second locations.

CONCLUSION

Atypic forms are not rare. MU is commonly recurrent, multiple, early arising and may appear in young people. The treatment of chronic wounds cannot be dissociated from the treatment of contractures, otherwise the wound will inevitably reappear.

[Hetero-digital toe flap according to the « spare-part » concept taken from a duplicated toe for the treatment of a cutaneous flessum of an associated clinodactyly]

INTRODUCTION

The correction of cutaneous deficiency encountered in clinodactyly is an important aspect of its treatment. The use of the skin lining of an adjacent duplicated toe as a « spare-part » flap may be of interest in providing good quality tissue.

CLINICAL CASE

We report the case of a child with complete duplication of the 5th toe associated with clinodactyly. The use of a heterodactyl flap taken from the amputated toe allows the release of a plantar cutaneous flange of the preserved toe.

DISCUSSION

The concept of « spare-part » flap is mainly used in hand surgery in traumatic lesions of the fingers. Its application in the treatment of clinodactyly on the occasion of the regularization of a polydactyly is also interesting because some fingers or toes are intended to be amputated to render a classical anatomy of five-toed foot. It is necessary for the realization of this type of flap on malformative toes to verify the existence of a distinct viable pedicle of the amputated toe, which can be done only intraoperatively.

CONCLUSION

The surgery for congenital malformations of the toes requires perfect management of the skin capital. The use of a « spare-part » toe flap taken from the toe to be amputated is a viable solution for the treatment of a cutaneous flessum encountered in a clinodactyly of the adjacent finger.

[Long-term strategy of the initial management of facial burns: About 3 cases]

INTRODUCTION

The management of facial burns in their acute stage determines most of the sequelae aspect. An initial treatment of good quality should reduce and even prevent scar ransom and should not compromise potential future corrections. This treatment is based on the respect of facial surgery standards and on the use of some particular technical points.

CASE REPORTS

We described our surgical protocol through three case reports. We are performing a surgical excision of the unhealed lesions between the 12th and 15th postburn day. This excision is followed by a dermoepidermal skin graft in the same operative time. This graft must be harvested from the scalp every time it is possible and must be manually perforated. All the aesthetic units junctions are necessarily respected. Flaps can be necessary at this stage.

DISCUSSION AND CONCLUSION

The long-term functional and cosmetic results observed in patients with facial burns vary a lot depending on the initial treatment. Patients with severe burns that benefited from an appropriate initial treatment may thus present better results than patients with less severe burns who were badly treated.

[Not Available]

A retrospective study was conducted to assess the interactions between epileptic seizure and burn. The study was conducted on all patients treated at the Saint Luc Saint Joseph Hospital Burn Unit from 2000 to 2015 with a diagnosis of epilepsy. Forty-eight cases associating burns and epilepsy were reviewed. Twenty-eight patients had a burn following an epileptic seizure. The average age was 43, and the burned area was 9%. Injuries resulted from contact with hot surface (32%), scald burn (50% - 32% with cooking water and 17.8% by accidental exposure to hot tap water (shower)). Burns by flames were rare (4 cases/28: 14.3%). The burns were deep, and all required surgical treatment by excision - split thickness skin graft. All the cases of tap water burns occurred before 2010 and the changes to hot tap water temperature legislation. Three patients presented a new epileptic seizure during their hospitalization. Primary prevention of domestic accidents, particularly regulation of hot tap water temperature, appears effective. Educating epileptic patients on the importance of therapeutic compliance and the elimination of risky activities during periods of therapeutic modification should further reduce the incidence of seizure-related burns.

[Not Available]

The use of lipostructure to treat burn sequelae is more and more common today. The regeneration capacities of mesenchymal stem cells appear promising on this sequelae skin, which is poorly vascularized, retractile and often painful. The aim of our study is to establish the analgesic properties, and the functional and aesthetic improvements gained by using lipostructure to treat burn sequelae. Forty-three patients who received lipostructure for burn sequelae according to the Coleman method between 2005 and 2017 were selected. Results regarding aesthetic, analgesic and mobility gain were recorded, with a minimum follow-up of one year postoperatively. Our patients consisted of 32 women and 11 men, with a mean age of 31.7 years (15 to 64 years). The mean follow-up during the study was 49.8 months (2 to 205 months). Patients received an average of 1.3 (1 to 3) sessions of lipostructure with an average of 153 cc (10 to 1040 cc) per session. Sequela sites were the face for 13 patients, the upper limb for 13 patients, the lower limb for 16 patients and the trunk for 4 patients. Twelve patients had lesions on multiple locations. Twenty patients benefited from this surgery for purely aesthetic or functional reasons, and 23 for painful sequelae. A significantly lower EVA was observed after surgery and a functional gain thanks to the restoration of no longer painful amplitudes. An aesthetic gain was also reported in more than three quarters of cases. In two cases, the analgesic effect decreased after one year and required a second lipostructure. The use of lipostructure in burn sequelae has already proved its efficiency with regard to the functional aspect, aesthetics and also analgesia. However, the evaluation of results is based on scales that are still imperfect. Lipostructure is not the only type of surgery used in burn sequelae. Local plasty or skin grafts are also used, but they are more invasive and have no direct analgesic effect. Lipostructure is only possible on mature, soft and non-adherent scars in order not to traumatize adipose cells. Post-burn skin is defined by retractions and adhesions to deep planes, requiring heavy rehabilitation work beforehand. Finally, the effect is not always sustainable and the duration of efficiency remains unknown. Lipostructure has its place in the treatment of hyperalgic and unsightly burn sequelae that are responsible for a functional and social disability in the patient.

[Not Available]

The 2018 topics were « burns to the upper limb, hand excluded » and « advances in analgesia and sedation ». The authors used both the notes they took during the session and video footage to write this report. The reader should get in touch with the lecturer if more in-depth information is required.

[Not Available]

At the end of 2013, we proposed the possibility of obtaining specialized burn advice 24/7 via pictures transmitted through a dedicated email address, to healthcare professionals. This simple tool is now a success, and we received one request for advice per day in 2015, resulting in an exchange of numerous emails. This simple process offers a number of benefits: it allows burn centres to regulate patient flows all year long, gives healthcare professionals access to a burn care specialist when and as quickly as they need, ensures each patient receives dedicated care, and allows national authorities to provide the best public health service and gain financial profits. However, a tool that uses email is much too simple and insufficiently secure, therefore it can only represent the first step towards a much more "professional" solution.

[The advantages in using cyanoacrylate glue over skin staples as a method of skin graft fixation in the pediatric burns population]

INTRODUCTION

Local postoperative care and burn wound management can present with a certain degree of difficulty in the pediatric population. While the use of skin staples as a method of skin graft fixation is a well-known, rapid and simple method, their removal can be painful and may necessitate some sedation or even general anesthesia. We studied in this article the advantages and economic value of using the cyanoacrylate glue as a fixation method for skin grafts.

MATERIALS AND METHODS

A comparative study was carried out from 2012 to 2016. Hundred and eighteen infants with burns up to 5% of total body surface area were included in the study. Seventy-two infants had split thickness skin grafts fixed with skin staples. Forty-six infants had split thickness skin grafts fixed with cyanoacrylate glue. We compared the quality of graft, the sedation used during the first postoperative dressing, the length of hospital stay, the amount of glue used and the presence of complications.

RESULTS

There is a difference between the two groups studied in terms of age and total burn surface area. The rate of graft take was 100% in both groups. The first postoperative dressing was carried out without the use of powerful analgesia in the cyanoacrylate group, while it was necessary to use general anesthesia in 64% of the skin staples group. The average length of stay in hospital after skin grafting was 4.9 days for the cyanoacrylate glue versus 6.5 days in the skin staples group. No complications were noted in the 2 groups.

CONCLUSION

The use of cyanoacrylate glue allows rapid fixation of skin grafts and avoid general anesthesia for postoperative cares. Subsequently the length of hospital stay is reduced within 25%. The medico-economic value of glue protocol is highly significant compared to skin staples, while having similar good results and without significant problems.

Nose burns: 4-dimensional analysis

The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing grotesque facial disfigurement. As this disfigurement is visible on frontal and profile views, the patient suffers both socially and psychologically. The nose is a three-dimensional organ. Reconstruction is therefore more difficult and needs to be more precise than in other parts of the face. Maintaining symmetry, contour and function are essential for successful nasal reconstruction. Multiple factors determine the optimal method of reconstruction, including the size of the defect, its depth and its site. Satisfactory social life is recovered only after multiple surgical procedures and long-term rehabilitation and physiotherapy.

Is there any place for spontaneous healing in deep palmar burn of the child?

Child palm burns arise by contact and are often deep. The singular difficulty of such a disease comes from the necessity of the child growth and from the potential occurrence of constricted scars. In order to avoid sequelae, the actual gold standard is to practice an early excision of the burn, followed by a skin graft. The aim of this study is to evaluate the results of spontaneous healing combined with rehabilitation versus early skin grafting and rehabilitation concerning the apparition of sequelae. We performed a retrospective study in two burn centers and one rehabilitation hospital between 1995 and 2010. Eighty-seven hands have been included in two groups: one group for spontaneous healing and the other group for excision and skin grafting. Every child benefited from a specific rehabilitation protocol. The two main evaluation criteria were the duration of permanent splint wearing and the number of reconstructive surgery for each child. The median follow-up duration is about four years. The two groups were comparable. For the early skin grafting group, the splint wearing duration was 1/3 longer than for the spontaneous healing group. Concerning the reconstructive surgery, half of the grafted hands needed at least one procedure versus 1/5 of spontaneous healing hands. Our results show the interest of spontaneous healing in palmar burn in child, this observation requires a specific and intense rehabilitation protocol.

[Management of eyelid burns]

Burns are devastating injuries scarring patients, both physically and psychologically, for life. This remains particularly true for facial burns. Eyelid burns occur in about 10% of thermal injuries and is a considerable challenge for the reconstructive surgeon given the particular anatomy of the eyelids. Reconstruction of the eyelids following burn injuries has been performed by plastic surgeons since the earliest days of reconstructive surgery, yet a consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. Controversies exist regarding the excision and debridement of eschar, temporary suture and surgical tarsorrhaphy, timing of surgery for eyelid contraction, and the role of full and split-thickness skin grafts in eyelid reconstruction. This paper describes the particularities of the treatment of burned eyelids in our Burn Center.

[Weight variation after reduction mammary surgery: retrospective study of 100 cases]

INTRODUCTION

Patients desiring breast reduction are often in overweight, and describe interferences with their daily life and minor psychological problems. We undertook this study to establish the pre- and postoperative weight pattern by age and histological breast type.

PATIENTS AND METHODS

A retrospective review was performed on 100 consecutive patients who underwent bilateral reduction mammaplasty for macromastia (>300g per breast) in 2007. The patients were categorized by age in two groups: group 1 (G1) comprising the 50 younger patients (mean age: 35.5 years) and group 2 (G2) comprising the 50 older (mean age: 47.2 years). We obtained data points including: preoperative and postoperative weight pattern according to age and histological subtypes, calculation of body mass index (BMI), data from surgery including amount of resection, postoperative course and complications.

RESULTS

Patients consulting for breast reduction are moderately overweight (mean BMI: 28.22 confounded all ages). Preoperative weight loss is low despite systematic surgeon request (<0.5 % on average waiting time of 6.45 months). The postoperative weight loss is higher in young patients with glandular form of HTM (respectively -4.76 kg for glandulofibrous type and -3kg for fibrous, which corresponds to a loss of 6.5 and 4.1 % of their body weight). The impact of surgery on the patient's psychological condition is better in young patients.

CONCLUSION

This study demonstrated that postoperative weight loss after breast reduction are significant only in young patients with a constitutional type of macromastia (glandular or mixed forms). We believe that in addition to the functional improvement associated with surgery, these young patients lose weight they initially take to harmonize their silhouette.

[Surgical issues and outcomes in ischial pressure sores treatment]

INTRODUCTION

Ischiatic pressure sores are frequent in spinal cord injury patients, associated with bad prognosis and high recurrence rate. Many surgical techniques were described, including surgical debridement followed by pedicled flap coverage. We aim to propose a practical decision tree for primary or secondary ischial pressure sore treatment.

PATIENTS AND METHOD

Our series of 48 operated ischial sores with an average follow up of 4 years (range 2 to 8years) is analyzed and compared to previously published reports. Surgical techniques are discussed according to their specific indications.

RESULTS

The optimal recurrence rate in published reports about pressure sore treatment is 20%; a rate inferior to 19% is found in our series, showing the equal importance of flap selection and postoperative care and education. Depending on each situation, various available flaps are described and compared: gluteus maximus flap, biceps femoris flap, gracilis flap, tensor fascia lata flap, fasciocutaneous thigh flaps, rectus femoris and vastus lateralis flap, rectus abdominis flap. Specific surgical indications for more extensive wounds are studied: resection arthroplasty of the hip, hip disarticulation, fillet flaps from the leg, microsurgery.

CONCLUSION

Based upon our experience, a decision tree summarizes our proposition of flap selection, depending on the wound size and the patient background.

[Contributions and results of lipo-structure in repair and rejuvenation of frontal anatomical unit]

Forehead is the most large anatomical unit of face. It includes forehead and anterior part of temple. Deteriorations of frontal anatomical units are numerous, ageing forehead has atrophy with eyebrow ptosis. In this work, we want to estimate contribution of lipo-structure in repair and rejuvenation of frontal anatomical unit (FAU). We present seven cases of repair of FAU and three cases of rejuvenation of the forehead. Results are satisfactory, particularly about frontal band. Results are questionable about Lipo-structure of temple. Applications of Lipo-structure in plastic and aesthetic surgery of the forehead are huge. Lipo-structure is the reference technique of volumetric filling. It is preferred to other techniques as flaps (pediculed or free) or materials, because it is a safe, easy and efficient technique, which permits large fillings. In aesthetic surgery, Lipo-structure gives volume to eyebrow region and fills root of the nose. It can be used with injections of botulinum toxin A. Lipo-structure of forehead takes part in rejuvenation of eye and nose. In conclusion, lipo-structure is actually the major technique of filling with a large implication in plastic and aesthetic surgery of FAU.

Traitement des séquelles de brûlures du cuir chevelu par expansion cutanée: mise au point

Deep burns of the scalp responsible of alopecia, used to be a real surgical challenge until apparition of tissue expansion in the 1980's. Tissue expanders are in this way employed in our unit of plastic surgery since more than 20 years, especially for head and neck reconstruction after burns. Thanks to operators and teams experience, incidence of postsurgical complications is still decreasing; in the same time, many improvements have been performed, regarding to surgical technique, choice of expanders (size, location...), or shape of flaps. All those technical details are discussed in order to optimize surgical results.

[Insulin-induced lipohypertrophy treated by liposuction]

The incidence of insulin-dependent diabetes mellitus increase permanently, with early diagnosis. Insulin is the treatment of this pathology. Insulin therapy is associated with complication such as lipodystrophies at injection sites leading functional and aesthetics disorders (pain, reduction of treatment efficiency, haematomas and oedemas). Our report two cases to illustrate the effectiveness of the suction-assisted lipectomy (SAL) on these lipodystrophies. We present two cases of insulin dependent diabetics patients with lipodystrophies of thighs, abdomen, and shoulders treated by SAL. The various analyzed parameters are: aesthetic aspect, efficiency of insulin treatment, ease injection, and pain reduction. We observe a significant reduction of insulin dose necessary to obtain a normoglycemia half time. This treatment allow a better control of pain, control of haematomas and oedemas at the injection sites and an aesthetic improvement. The lipoaspiration is thus a simple and effective treatment of lipodystrophies due to insulin.

Brûlures graves de la main et lambeaux : choix thérapeutiques et revue de la littérature

Deep hand burns often leads to major deformities, involving cosmetic and functional disease as scar contracture, stiffness, or even amputation. Early surgical treatment and rehabilitation are always challenging but crucial in order to prevent burn sequelae. When tendinous, osseous, nervous or vascular component are involved, even hand vitality is engaged: cutaneous, fasciocutaneous, muscular or musculocutaneous flaps are then the only way of salvage for the hand. The purpose of this surgery is the early covering of essential components, allowing early rehabilitation and mobilisation. The problem remains the choice of surgical covering, according to the site, size, and depth of the burn, and local reliable opportunities. Care must be taken to preserve surgical ways for final sequela reconstruction.

Le lambeau-greffe abdominal : intérêt pour la couverture des pertes de substance tégumentaires dorsales de la main et des doigts chez le brûlé. À propos de six cas

We report six cases of abdominal flap-graft used to cover post-burn soft tissue defects of hands. The technique used was first described by Colson and is applied in our study to an abdominal donor site. Debulking of the flap at the time of elevation resulted in a skin quality as good as a full thickness graft without jeopardizing flap vitality and reliability. Digit mobilization was possible after separation. Long term functional results were found to be satisfactory, specially for the hand. For the fingers it is mostly a digit-rescue surgery. The application of this technique remains sparse. Still, the abdominal flap-graft is often useful in cases of burn patients because of the poor local conditions, as well as the magnitude and nature of injury, which limit the coverage options.

Place de la réduction mammaire à pédicule supérieur dans les gigantomasties

SUBJECT

The authors present technical details, complications, morphologic and aesthetic results of 26 breast reduction mammaplasty for macromastia (breast reduction more than 1000 g) showing advantages and reliability of technique.

MATERIALS AND METHODS

From January 2000 to December 2001, 223 patients underwent bilateral reduction mammaplasty with superior-based pedicled dermo-glandular flap. In 26 of them the weight of removed mammary tissue was over 1000 g in each breast. These 26 cases were evaluated, and the criteria adopted to analyse the results was morphologic and aesthetic evaluation of patient herself (very good, good, acceptable, unacceptable).

RESULTS

Mean follow-up for all patients was 15 months. Twenty-six patients (mean age 33.2 years) underwent an average weight of 1131 g (930/2200 g) removed per breast. The following complications were observed: 1 Nipple Areolar Complex ischemia without necrosis; three infections (abscess); four delayed wound closure. The patient subjective evaluation of result was: "very good" in 19 cases (73%); "good" in 5 cases (19.2%) and "acceptable" in the others two cases (7.8%). No case was evaluated "unacceptable".

CONCLUSION

Superior dermoglandular pedicle mammaplasty represent a very good and reliable solution for the treatment of macromastia, giving satisfactory cosmetics results with good nipple viability without necrosis. This technique is actually our first choice in the management of macromastia.

[Clinical evaluation of structural fat tissue graft (Lipostructure) in volumetric facial restoration with face-lift. About 100 cases]

INTRODUCTION

Adipose tissue has been used for volume restoration for over a century. Coleman's Lipostructure is a recent procedure for adipocyte transfer, based on strict methodology and the use of specific material. Our aim in this work is to provide an answer to several questions: what is the place of this technique in the restoration of facial volumes? Do aesthetic subunits have an impact on the result?

MATERIAL AND METHODS

This retrospective study concerned 100 patients who had undergone volumetric facial restoration with face-lift and Lipostructure. A five-member jury carried out subjective evaluation through a questionnaire sent to the patients, and objective evaluation by assessment of pre- and postoperative photographs.

RESULTS

Mean time since surgery was 15 months. Overall patient satisfaction was 82% with a mean score of 15/20 on subjective evaluation and of 13.3/20 on objective evaluation. The results differed significantly according to the facial aesthetic subunit involved, the best results being obtained in the malar region and the cheek, and the least satisfactory in the upper and lower lips. This technique has few drawbacks. Prolonged oedema is the only complication (8%).

CONCLUSION

We consider that at the present time Lipostructure is the best means of restoring facial volume. It is a simple, effective and reproducible technique. Its application in all fields of plastic surgery is an essential adjunct to our specialty.

Réparation des ruptures de poulie chez le grimpeur

INTRODUCTION

Twelve high-level rock climbers were operated on for flexor tendon pulley rupture. Circumstances of pulley rupture and contributing factors are studied; postoperative improvement is evaluated by rock climber level increase, compared to the initial level.

METHOD

Average age was 28 years and there were nine males and three females; all of them were high-level rock climbers, succeeding at least in 7a climbing ways before the accident. The surgical procedure was to replace the deficient pulley using an extensor retinaculum graft.

RESULTS

The non-dominant hand was the most frequently involved, and especially A2 pulley of the fourth finger. Diagnosis was easy and clinically established.

DISCUSSION

Medical or functional treatments never allowed climbers to reach their former level. The only efficient treatment was surgical, whatever the time elapsed between injury and surgery. After this surgical procedure, five of the twelve patients improved their results, five recovered their former level and two decreased. The results are analysed and compared to other surgical procedures.

CONCLUSION

Surgical repair of rupture of flexor tendon pulley during sport is the only efficient treatment allowing the rock climber to recover and improve its performance.

[Anchovy dacron arthroplasty in the treatment of basal osteoarthritis of the thumb: long term results]

INTRODUCTION

Fifteen patients were treated for arthritis of the base of the thumb by trapieziumectomy and anchovy interposition using Dacron[symbol: see text]. The results are described.

METHODS

The 15 patients were between 42- and 68-years-old at the time of operation. The mean postoperative follow-up was 3 years. Pain, pinch strength, opposition, opening of the first web space and height of the space formerly occupied by the trapezium were clinically and radiologically evaluated.

RESULTS

Pain had completely disappeared in more than 80% of the patients. The mean post-surgical opposition was 8.9/10 (Kapandji score). The pinch strength and first web-space opening were improved, whereas the height of the trapezium site was always reduced by 25%. The only complication was one case of reflex sympathetic dystrophy: no case of foreign body reaction was reported. Eleven of the 15 patients were satisfied with the operation, and noted better thumb function in everyday life.

DISCUSSION

The treatment of arthritis of the base of the thumb by means of trapieziumectomy and anchovy interposition is effective with respect to pain in all the studies previously published, whatever the technique used. Mobility is preserved, contrary to arthrodesis, and grip strength remains compatible with the patient's daily life. The choice of a synthetic anchovy such as Dacron[symbol: see text] allows a quicker operation and better than the ones involving sacrifice of a tendon at the wrist. Anchovy interposition remains the preferred alternative among other procedures in the treatment of basal osteoarthritis of the thumb.