Docteur BALAGUER Thierry, Chef de service de Chirurgie Esthétique-Réparatrice, Chirurgie de la main à l'IULS du CHU de Nice

Dr BALAGUER Thierry

Chirurgie Réparatrice & Esthétique
Chirurgie de la Main

Chef de Service
Praticien Hospitalier

Secrétariat:
Tel.: 04.92.03.38.12
Mail: dijoux.i@chu-nice.fr

Isabelle Dijoux

Isabelle DIJOUX, secrétariat Chirurgie Réparatrice – Esthétique, Chirurgie de la Main à l'IULS du CHU de Nice

Titres

  • Ancien interne des Hôpitaux de Nice
  • Ancien assistant des Hôpitaux, Chef de Clinique à la Faculté de Médecine de l’Université de Nice-Sophia-Antipolis
  • Chirurgien Plasticien, Chirurgien de la Main
  • Praticien Hospitalier (2003)

Fonctions hospitalières

  • Responsable du Service de Chirurgie Réparatrice-Esthétique, Chirurgie de la Main, Hôpital Pasteur 2

Fonctions universitaires

  • Praticien de Recherche Associé CNRS : depuis le 01 novembre 06 Contrat interface CHU-CNRS pendant 2 années consécutives. Laboratoire GéPITOs « Génétique, Physiopathologie et ingénierie du tissu osseux » CNRS/UNSA, UMR6235. Faculté de Médecine de Nice, Directeur Georges Carle.

Diplômes

  • Certificat C1 Anatomie et organogénèse
  • Certificat C2 Anatomie spécialisée chirurgicale
  • Maîtrise en Sciences biologiques et médicales
  • DEA Paléontologie humaine (Muséum National d’Histoire Naturelle, Pr. H de Lumley), Reconstruction faciale tridimensionnelle manuelle : Méthodologie, évaluation, applications.
  • Doctorat en Sciences de la Vie et de la Santé
  • DES Chirurgie générale
  • DESC Chirurgie plastique, réparatrice et esthétique
  • DIU Chirurgie de la main
  • DU Recherches micro chirurgicales
  • Membre de la Société Française de Chirurgie de la Main, Groupe d’Etude de la Main

The radial forearm free flap: a review of microsurgical options

The radial forearm free flap: a review of microsurgical options

Victor Médard de Chardon, Thierry Balaguer, Bérengère Chignon-Sicard, Younes Riah, Tarik Ihrai, Emad Dannan, Elisa Lebreton

https://pubmed.ncbi.nlm.nih.gov/18851935/

Abstract

The radial forearm free flap, highly regarded in head and neck reconstructive surgery, is known to be one of the most reliable and versatile flaps. The microsurgery is usually easy to perform due to large vessels and a long pedicle; the double superficial and deep venous networks allow many microsurgical options. The sensory nerve coaptation, still debated for weight-bearing foot reconstruction and its sensory restoration, has recently undergone technical refinements. The authors review the microsurgical options for microvascular anastomosis and for sensory restoration.

Close

Necrotizing fasciitis: complication of patient positioning?

Necrotizing fasciitis: complication of patient positioning?

V Médard de Chardon, N Guevara, L Lattes, S Converset-Viethel, Y Riah, E Lebreton, J Santini, T Balaguer

https://pubmed.ncbi.nlm.nih.gov/17959297/

Abstract

Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. It disseminates along fascias with a mortality sometimes within 18 hours. The average mortality, reported in the literature, is about 30%. A 65-year-old man, with a history of Vaquez disease (under hydroxurea) and a smoke addiction, had an epidermoid carcinoma of the left vocal cord (T2 N0 M0). The cancer treatment consisted of a functional lymph node excision, followed by tracheotomy then by partial laryngectomy. At the end of the intervention, after removal of operative fields, it was noticed that the Montandon cannula had slid and was between the medial side of the left upper limb and the lateral side of the chest. There was a cutaneous imprint with ecchymosis on the route of the cannula. At the second postoperative day, a necrotizing fasciitis quickly developed on the left side of the chest, the medial side of the left upper limb, and the left hip without infection of the operating site. An Escherichia coli was identified in tracheal secretions and operative samples. The presumed hypothesis of this necrotizing infection is the cutaneous contamination of the thoracic wall by tracheal secretions colonized by E. coli, whose penetration was induced by the cutaneous traumatism due to the cannula. We remind, by analyzing this unusual case, the caring principles one of which diagnosis and the surgical excision must be as premature as possible. We insist on the elementary measures of protection of the support points and the good binding of cannulas.

Close

Perilunate dislocations and fracture-dislocations of the wrist, a review of 14 cases

Perilunate dislocations and fracture-dislocations of the wrist, a review of 14 cases

A Martinage, T Balaguer, B Chignon-Sicard, M-C Monteil, N Dréant, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/18164230/

Abstract

Objectives: We report a retrospective series of 14 dislocations or perilunate fracture-dislocations. The results of our series are compared with the data of the literature and we discuss epidemiology, types of lesions, surgical treatment, complications and prognosis of this pathology.

Methods: The series included seven pure dislocations and seven fracture-dislocations including three trans-scapho-lunate forms (including one Fenton’s syndrome). The displacement of all these lesions was posterior. The mean age was 35 years. Sixty-four percent were manual workers. All 14 patients had undergone surgical treatment through a dorsal approach in the first seven days following the injury. They were reviewed clinically and radiologically with a mean follow-up of 25 months.

Results: The average Cooney functional score was 72/100 with two excellent, six good, four fair and two poor results. Average flexion-extension motion arc was 74%, the grip strength was 77% compared to the other wrist. Persistent wrist pain was almost constant. One carpal instability was observed and one patient required a four-corner arthrodesis for SLAC wrist. Eighty-five percent of all patients were employed at least.

Conclusions: Early diagnosis and anatomical reduction can provide satisfactory functional results. Emergency surgical treatment is required. We prefer a dorsal approach and we do not perform primary closed reductions.

Close

Vascularized transfer of the whole flexor apparatus from a finger to another : The use of the spare-parts concept applied to a case of electrical burn

Close

Surgical treatment of the boxer's fracture: transverse pinning versus intramedullary pinning

Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning

A Martinage, T Balaguer, B Chignon-Sicard, M-C Monteil, N Dréant, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/17993437/

Abstract

The purpose of this study was to compare the surgical treatment of fractures of the little finger metacarpal neck, or « Boxer’s » fractures, by transverse pinning and intramedullary pinning. Thirty-six patients with fracture of the neck of the fifth metacarpal were included in a prospective comparative randomised study. A palmar splint was applied for 1 week after both procedures. Patients began physiotherapy three times per week for 30 days. The patients were evaluated clinically six times after surgery, up to the 90th day, with X-ray assessment on days 8, 45 and 90. The study showed that intramedullary pinning gave better functional outcomes than transverse pinning, although the former was more technically demanding.

Close

Traumatic pseudo-boutonniere of the metacarpophalangeal joint of the little finger. Case report and review of the literature

Traumatic pseudo-boutonniere of the metacarpophalangeal joint of the little finger. Case report and review of the literature

M C Monteil, T Balaguer, B Chignon-Sicard, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/16841771/

Abstract

Dislocation of the extensor tendon over the metacarpophalangeal joint is common among patients with rheumatoid arthritis. Patients without arthritis are exceptionally involved. The authors describe a new case of traumatic boutonniere-like of the metacarpophalangeal joint of the little finger. This lesion is a rarely, only eleven cases are described in literature. Patients are usually young adults and dislocation is related to a direct axial trauma on their fifth metacarpophalangeal joint. Diagnosis is clinical and relies on an incomplete active extension of the metacarpophalangeal joint, secondary to the dislocation of the extensor apparatus. Diagnosis is often delayed the lesion remaining unnoticed with the occurrence of others hand lesions. Proper treatment is surgery, based on suturing side to side both extensor digiti minimi and common extensor tendon over the fifth metacarpophalangeal joint. Results are excellent, with a complete range of motion and the absence of recurrence.

Close

Distally based first web flap for coverage reconstruction of the great toe

Close

Replantation digitale hétérotopique chez un homme de 80 ans

Heterotopic digital transplantation in an 80-year-old man (Replantation digitale hétérotopique chez un homme de 80 ans)

N Dreant, T Balaguer, A Martinage, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/15195585/

Abstract

The authors report a case of amputation of the first, second and third fingers of the left hand in an 80-year old man. As the thumb was not replantable, a pollicization by hetero-replantation of the index was performed as an emergency. With a 1-year follow-up, the functional result was satisfactory. Analysis of the case report again shows that in the case of thumb amputation, hetero-replantation according to the principles of « finger-bank » is the solution of choice and demonstrates its feasibility in the elderly. The authors discuss the recovery of sensation.

Close

The radial forearm free flap: a review of microsurgical options

The radial forearm free flap: a review of microsurgical options

Victor Médard de Chardon, Thierry Balaguer, Bérengère Chignon-Sicard, Younes Riah, Tarik Ihrai, Emad Dannan, Elisa Lebreton

https://pubmed.ncbi.nlm.nih.gov/18851935/

Abstract

The radial forearm free flap, highly regarded in head and neck reconstructive surgery, is known to be one of the most reliable and versatile flaps. The microsurgery is usually easy to perform due to large vessels and a long pedicle; the double superficial and deep venous networks allow many microsurgical options. The sensory nerve coaptation, still debated for weight-bearing foot reconstruction and its sensory restoration, has recently undergone technical refinements. The authors review the microsurgical options for microvascular anastomosis and for sensory restoration.

Close

Necrotizing fasciitis: complication of patient positioning?

Necrotizing fasciitis: complication of patient positioning?

V Médard de Chardon, N Guevara, L Lattes, S Converset-Viethel, Y Riah, E Lebreton, J Santini, T Balaguer

https://pubmed.ncbi.nlm.nih.gov/17959297/

Abstract

Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. It disseminates along fascias with a mortality sometimes within 18 hours. The average mortality, reported in the literature, is about 30%. A 65-year-old man, with a history of Vaquez disease (under hydroxurea) and a smoke addiction, had an epidermoid carcinoma of the left vocal cord (T2 N0 M0). The cancer treatment consisted of a functional lymph node excision, followed by tracheotomy then by partial laryngectomy. At the end of the intervention, after removal of operative fields, it was noticed that the Montandon cannula had slid and was between the medial side of the left upper limb and the lateral side of the chest. There was a cutaneous imprint with ecchymosis on the route of the cannula. At the second postoperative day, a necrotizing fasciitis quickly developed on the left side of the chest, the medial side of the left upper limb, and the left hip without infection of the operating site. An Escherichia coli was identified in tracheal secretions and operative samples. The presumed hypothesis of this necrotizing infection is the cutaneous contamination of the thoracic wall by tracheal secretions colonized by E. coli, whose penetration was induced by the cutaneous traumatism due to the cannula. We remind, by analyzing this unusual case, the caring principles one of which diagnosis and the surgical excision must be as premature as possible. We insist on the elementary measures of protection of the support points and the good binding of cannulas.

Close

Perilunate dislocations and fracture-dislocations of the wrist, a review of 14 cases

Perilunate dislocations and fracture-dislocations of the wrist, a review of 14 cases

A Martinage, T Balaguer, B Chignon-Sicard, M-C Monteil, N Dréant, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/18164230/

Abstract

Objectives: We report a retrospective series of 14 dislocations or perilunate fracture-dislocations. The results of our series are compared with the data of the literature and we discuss epidemiology, types of lesions, surgical treatment, complications and prognosis of this pathology.

Methods: The series included seven pure dislocations and seven fracture-dislocations including three trans-scapho-lunate forms (including one Fenton’s syndrome). The displacement of all these lesions was posterior. The mean age was 35 years. Sixty-four percent were manual workers. All 14 patients had undergone surgical treatment through a dorsal approach in the first seven days following the injury. They were reviewed clinically and radiologically with a mean follow-up of 25 months.

Results: The average Cooney functional score was 72/100 with two excellent, six good, four fair and two poor results. Average flexion-extension motion arc was 74%, the grip strength was 77% compared to the other wrist. Persistent wrist pain was almost constant. One carpal instability was observed and one patient required a four-corner arthrodesis for SLAC wrist. Eighty-five percent of all patients were employed at least.

Conclusions: Early diagnosis and anatomical reduction can provide satisfactory functional results. Emergency surgical treatment is required. We prefer a dorsal approach and we do not perform primary closed reductions.

Close

Vascularized transfer of the whole flexor apparatus from a finger to another : The use of the spare-parts concept applied to a case of electrical burn

Close

Surgical treatment of the boxer's fracture: transverse pinning versus intramedullary pinning

Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning

A Martinage, T Balaguer, B Chignon-Sicard, M-C Monteil, N Dréant, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/17993437/

Abstract

The purpose of this study was to compare the surgical treatment of fractures of the little finger metacarpal neck, or « Boxer’s » fractures, by transverse pinning and intramedullary pinning. Thirty-six patients with fracture of the neck of the fifth metacarpal were included in a prospective comparative randomised study. A palmar splint was applied for 1 week after both procedures. Patients began physiotherapy three times per week for 30 days. The patients were evaluated clinically six times after surgery, up to the 90th day, with X-ray assessment on days 8, 45 and 90. The study showed that intramedullary pinning gave better functional outcomes than transverse pinning, although the former was more technically demanding.

Close

Traumatic pseudo-boutonniere of the metacarpophalangeal joint of the little finger. Case report and review of the literature

Traumatic pseudo-boutonniere of the metacarpophalangeal joint of the little finger. Case report and review of the literature

M C Monteil, T Balaguer, B Chignon-Sicard, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/16841771/

Abstract

Dislocation of the extensor tendon over the metacarpophalangeal joint is common among patients with rheumatoid arthritis. Patients without arthritis are exceptionally involved. The authors describe a new case of traumatic boutonniere-like of the metacarpophalangeal joint of the little finger. This lesion is a rarely, only eleven cases are described in literature. Patients are usually young adults and dislocation is related to a direct axial trauma on their fifth metacarpophalangeal joint. Diagnosis is clinical and relies on an incomplete active extension of the metacarpophalangeal joint, secondary to the dislocation of the extensor apparatus. Diagnosis is often delayed the lesion remaining unnoticed with the occurrence of others hand lesions. Proper treatment is surgery, based on suturing side to side both extensor digiti minimi and common extensor tendon over the fifth metacarpophalangeal joint. Results are excellent, with a complete range of motion and the absence of recurrence.

Close

Distally based first web flap for coverage reconstruction of the great toe

Close

Replantation digitale hétérotopique chez un homme de 80 ans

Heterotopic digital transplantation in an 80-year-old man (Replantation digitale hétérotopique chez un homme de 80 ans)

N Dreant, T Balaguer, A Martinage, E Lebreton

https://pubmed.ncbi.nlm.nih.gov/15195585/

Abstract

The authors report a case of amputation of the first, second and third fingers of the left hand in an 80-year old man. As the thumb was not replantable, a pollicization by hetero-replantation of the index was performed as an emergency. With a 1-year follow-up, the functional result was satisfactory. Analysis of the case report again shows that in the case of thumb amputation, hetero-replantation according to the principles of « finger-bank » is the solution of choice and demonstrates its feasibility in the elderly. The authors discuss the recovery of sensation.

Close