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    none: Fig. 20. A, bistouri coupant à plein tranchant du bord libre vers l'extrémité métacarpienne. B, bistouri plongé par transfixion à la base des doigts et coupant la palme de dedans en dehors. C, bistouri agissant de la pointe et divisant la membrane unissante de dehors en dedans. D, Membrane coupée de bas en haut avec des ciseaux
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    none: 0176 - Page 176 - Méthode de l'incision modifiée. 1° Procédé de Eudtorffer
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    none: Fig. 21. Aiguille lancéolée, portant un fil de plomb B ; la pointe A traverse le pli interdigital au point où l'on veut établir la nouvelle commissure C ; le fil B ayant traversé le pli est enroulé à ses extrémités de manière à ne point s'échapper. - Lorsque le trajet O de ce fil est cicatrisé isolément, on y introduit un bistouri boutonné D, et on divise la membrane unissante jusqu'à son bord libre
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    none: Fig. 22. Une lancette A perfore la membrane interdigitale au point O ; on introduit par cette ouverture une mince lame de plomb B, qu'on enroule ensuite pour assurer la fixité ; anse de fil CC traversant la palme au point O, et munie à ses deux extrémités d'un poids pour opérer la section lente de la membrane interdigitale
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    none: 0179 - Page 179 - 2° Procédé de Beck / B. Méthode de la compression. 1° Procédé de Dupuytren
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    none: Fig. 23. AAA, les interstices digitaux sont rendus libres par la section des membranes unissantes ; bandelette BBB, rollées autour des doigts séparés pour empêcher la réunion ; C, bandelette de diachylon comprimant l'angle de réunion des plaies latérales et fixées sur les faces dorsale et palmaire du poignet par une bandelette circulaire D ; E, plaque de plomb, placée de champ dans l'angle de la division pour remplir le même but
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    none: Fig. 24. Palette de bois digitée pour fixer isolément les doigts séparés
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  none: 0182 - Page 182 - 2° Procédé de M. Maisonneuve
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    none: 0182 - Page 182 - 2° Procédé de M. Maisonneuve
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    none: Fig. 25. Procédé de M. Maisonneuve. Instrument composé de deux tiges métalliques A, B, prismatiques triangulaires, mobiles, et réunies par deux vis CC, pointues à un bout et terminées à l'autre par une virole
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  none: 0185 - Page 185 - C. Méthode de la cautérisation
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    none: 0185 - Page 185 - C. Méthode de la cautérisation
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  none: 0187 - Page 187 - D. Méthode de la ligature. Premier procédé
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    none: 0187 - Page 187 - D. Méthode de la ligature. Premier procédé
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    none: Fig. 26. Section de la membrane unissante par la ligature et la cautérisation - Procédés de M. A. Severin et de Krimer
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  none: 0189 - Page 189 - Autre procédé / E. Méthode de l'excision de la cicatrice. Procédé Ph. Boyer
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    none: 0189 - Page 189 - Autre procédé / E. Méthode de l'excision de la cicatrice. Procédé Ph. Boyer
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    none: Fig. 27. La membrane interdigitale est saisie entre les deux mors d'une pince à pansement ordinaire A ; le bistouri B, suivant les bords de cette pince, pratique deux incisions parallèles C et C'qu'isole une sorte de languette charnue D, qu'on excise ensuite avec des ciseaux E. - Les doigts séparés sont alors entourés d'une bandelette de diachylon, afin que les plaies latérales ne se réunissent point
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  none: 0191 - Page 191 - F. Méthode de destruction de la cicatrisation de la commissure. Procédé d'Amussat
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    none: 0191 - Page 191 - F. Méthode de destruction de la cicatrisation de la commissure. Procédé d'Amussat
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  none: 0192 - Page 192 - Deuxième groupe de procédés opératoires. Méthode de la suture
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    none: 0192 - Page 192 - Deuxième groupe de procédés opératoires. Méthode de la suture
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    none: Fig. 28 A, B, la membrane unissante interdigitale (elle est, dans toutes ces planches, représentée beaucoup plus large qu'elle ne l'est réellement dans les cas de syndactylie. Cette exagération a pour but de rendre les figures plus faciles à comprendre). - C'C'C', fils passés à travers cette membrane au point où l'on veut établir la nouvelle commissure avant de pratiquer l'incision D. - Les doigts étant séparés dans toute la hauteur, les trois fils C C C sont noués et réunissent la commissure par trois points de suture ; les plaies latérales sont recouvertes de bandelettes, comme en F, ou abandonnées à elles-mêmes, comme en E
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  none: 0195 - Page 195 - Procédé de la suture des plaies latérales
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    none: 0195 - Page 195 - Procédé de la suture des plaies latérales
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    none: Fig. 29. A, B, la membrane interdigitale divisée en D par une incision longitudinale. - C C C, position des points de suture. - C'C'C', fils de tinés à réunir les lèvres ou plaies latérales ; ces fils pourraient être à la rigueur placés comme dans le procédé précédent, avant l'incision de la palme. - E E E, points de suture achevés sur un des côtés du doigt annulaire. Si l'étoffe manquait, on pourrait se contenter de réunir une seule des deux plaies digitales
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  none: 0196 - Page 196 - Troisième groupe de procédés opératoires (Autoplastie)
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    none: 0196 - Page 196 - Troisième groupe de procédés opératoires (Autoplastie)
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  none: 0197 - Page 197 - 1° Procédé de Zeller
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    none: Fig. 30. Les incisions C E, D E, pratiquées sur la face dorsale et ne comprenant que la peau, circonscrivent un lambeau à base métacarpienne, et dont le sommet atteint le niveau de la première articulation phalangienne. Ce lambeau L est disséqué et renversé sur le dos de la main ; une incision médiane A E, se continuant du côté de la face palmaire jusqu'aux limites supérieures de la palme, isole les doigts réunis. - Le lambeau L'est alors ramené dans l'angle de la division et fixé par un point de suture à la peau de la paume de main
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    none: 0200 - Page 200 - 4° Procédé de Didot. Manuel opératoire. Première partie (formation du lambeau dorsal)
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    none: 0201 - Page 201 - Deuxième partie (formation du lambeau palmaire)
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    none: Fig. 31. On devra comparer, pour bien comprendre le procédé de Didot, les trois figures suivantes. Celle-ci représente la manière de tailler les lambeaux à la face dorsale et de les disséquer
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    none: Fig. 32. Incision à la face palmaire
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    none: Fig. 33. Figure schématique destinée à montrer sur des coupes perpendiculaires à l'axe des doigts la position des lambeaux avant et après leur permutation et leur enroulement. La partie centrale ombrée représente l'os et sa doublure fibreuse
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    none: 0204 - Page 204 - 1° Procédé de M. Busi / 2° Procédé de M. Fano
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  none: 0205 - Page 205 - Procédé de M. Delore. Syndactylie congénitale complète
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    none: 0205 - Page 205 - Procédé de M. Delore. Syndactylie congénitale complète
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  none: 0207 - Page 207 - 4° Procédé de M. Cloquet / 5° Procédé de M. Pétrequin
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    none: 0207 - Page 207 - 4° Procédé de M. Cloquet / 5° Procédé de M. Pétrequin
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    none: Fig. 34. A L'espace interdigital effacé par la cicatrice unissante ; les incisions BB', se réunissant en bas, circonscrivent le tissu cicatriciel et permettent l'extirpation. - La seconde figure montre le résultat : la commissure A est redevenue libre ; les deux plaies linéaires BB', résultant de la réunion immédiate des lèvres palmaire et dorsale de chaque incision, sont rapprochées par des points de suture
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    none: Fig. 35. A, tumeur épidermique, circonscrite par les incisions B B B. Une incision C est pratiquée sur le milieu de la face dorsale du doigt médius. - Ce doigt est coupé transversalement au point D, de manière à ne conserver de peau que la longueur nécessaire pour recouvrir la plaie du dos de la main. - Les téguments du doigt E sont disséqués de manière à ce que la phalange puisse être extirpée
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    none: Fig. 36. B D C représente le lambeau cutané fourni par les téguments du médius après l'ablation de la phalange. - A D'C'représente la perte de substance créée à la face dorsale de la main par suite de l'extirpation de la tumeur. - Comme le lambeau et la plaie sont symétriques, il suffira de renverser le premier en arrière de manière à ce que les points D et C viennent s'appliquer aux points D'et C'; de cette façon la plaie sera comblée
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    none: Fig. 38. Lambeau taillé sur la face dorsale de l'esdace interdigital / Fig. 39. Avivement de la lèvre inférieure de la commissure
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