Papers by Nathalie Mobargha
Journal of Plastic Surgery and Hand Surgery, Sep 21, 2023
Ligamento-muscular reflex patterns following stimulation of a thumb carpometacarpal ligament: an ... more Ligamento-muscular reflex patterns following stimulation of a thumb carpometacarpal ligament: an electromyographic study. Manuscript.
The Journal of Hand Surgery, Sep 1, 2014
Both pinch strength (4.9 vs 3.6 kg, P¼0.029) and grip strength (26.3 vs 19.0 kg, P¼0.012) were si... more Both pinch strength (4.9 vs 3.6 kg, P¼0.029) and grip strength (26.3 vs 19.0 kg, P¼0.012) were significantly greater in the TMA group. There were no early complications in either group. Summary Points: At early follow up, patient-rated disability and function were similar among patients who underwent TMA and LRTI. TMA produced significantly greater pinch and grip strength compared to LRTI. Locking plate technology affords rigid fixation for TMA with promising early results noting reliable bony union while minimizing complications. REFERENCES 1. Calfee RP, Adams AA. Clinical research and patient-related outcome measures in hand surgery.
Journal of Hand Surgery (European Volume), Aug 6, 2015
Ligamento-muscular reflex patterns following stimulation of a thumb carpometacarpal ligament: an ... more Ligamento-muscular reflex patterns following stimulation of a thumb carpometacarpal ligament: an electromyographic study. Manuscript.
European Journal of Plastic Surgery, Jun 1, 2021
Background Objectively measured breast softness in reconstructed breasts and its relation to pati... more Background Objectively measured breast softness in reconstructed breasts and its relation to patients' subjective satisfaction with breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 year following delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) flap, using objective and subjective methods. Methods Seventy-three patients were randomised to breast reconstruction with an EP or DIEP flap between 2012 and 2018. Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary fold distance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluation was performed using the BREAST-Q questionnaire. Results Objectively, DIEP flaps were significantly softer than EP breast reconstructions. Non-operated contralateral breasts were significantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question (labelled 1.h) "How satisfied or dissatisfied have you been with the softness of your reconstructed breast (s)?" was higher in the DIEP flap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanation tonometry and the patient-reported satisfaction with the reconstructed breast's softness (r s = 0.37). Conclusions In terms of breast softness, breast reconstructions with DIEP flaps result in more satisfied patients. Concerning applanation tonometry as an objective tool for softness assessment, future studies on interobserver agreement are warranted.
International Journal of Surgery Case Reports, 2016
INTRODUCTION: Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a benign lesion with a ... more INTRODUCTION: Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a benign lesion with a female predominance and an aesthetically disturbing appearance. Spontaneous remission is not reported and medical treatments proposed so far have shown variable results. PRESENTATION OF CASE: We describe a rare case of an extensive variant of NHNA covering almost the entire breasts' surface. At present, only three other reports are present in the literature. Medical treatment proved not completely effective and the patient was also affected by a significant breast asymmetryhypertrophy. Therefore, NHNA was managed surgically with excision of the areolar affected portions while performing breast reduction-lift. The result was satisfactory and without recurrence of lesions at 5-year follow-up. DISCUSSION: This case reported favorable outcomes of surgery for NHNA. Reports of success with these procedures are still limited, but the promising results in terms of radicality and aesthetic outcome suggest it should be offered to patients as a viable therapeutic option. CONCLUSION: Indications for surgical treatment of NHNA can be: unsatisfying response to topical agents; young patients who want to restore the aesthetic appearance of the breast; and patients with concomitant indication for corrective surgery of the breast. Advantages are: predictable time of healing; predictable final result; radical excision of the affected tissue; and possibility of histologic analysis of the whole areola. In rare cases of lesions extending to the breast, preliminary treatment with topical agents can limit the extent of excision. Management and treatment should always be tailor-made for each individual case.
Journal of Plastic Surgery and Hand Surgery, Aug 3, 2021
The role of breast oedema in breast reconstruction is unknown. Therefore, our aim was to investig... more The role of breast oedema in breast reconstruction is unknown. Therefore, our aim was to investigate local tissue water (LTW) and breast oedema-related symptoms in breasts reconstructed with either an expander prosthesis (EP) or with a deep inferior epigastric perforator (DIEP) flap at a minimum of one year postoperatively. Sixty-eight patients randomised to breast reconstruction with an EP or DIEP flap completed follow-up. Objective evaluation was performed at a mean of 25 (standard deviation, SD 9.5) months following breast reconstruction, and included measurements of breast volume and LTW with the MoistureMeterDV R instrument. The patients completed the BREAST-Q questionnaire pre-and postoperatively. No significant differences in LTW were found when comparing EP and DIEP flap reconstructed breasts. The reconstructed breasts had an increase in LTW compared with the non-operated contralateral breasts. The BREAST-Q responses related to breast oedema symptoms were overall low and the median responses ranged from 1 to 2. A score of 1 indicated that symptoms were experienced 'None of the time'. Our findings indicate that mastectomy followed by breast reconstruction inflicts damage on the lymphatic system, shown as an increase in LTW. However, no breast oedema-related symptoms were reported in the BREAST-Q questionnaire, and therefore, we consider our objective results to be below a potential threshold for symptomatic breast oedema. A threshold for clinical indication of breast oedema remains to be defined.
The Journal of Hand Surgery, Mar 1, 2019
Purpose The dorsoradial ligament (DRL) is essential for stability of the first carpometacarpal jo... more Purpose The dorsoradial ligament (DRL) is essential for stability of the first carpometacarpal joint (CMC1) and is innervated with nerve endings and mechanoreceptors known to contribute to joint proprioception. The influence of these nerve endings on the neuromuscular stability of CMC1 is not yet known. This study investigated whether a ligamento-muscular reflex pathway is present between the DRL and CMC1 muscles. Methods Ten healthy subjects (5 women and 5 men, mean age 28 years; range, 24e37 years) were included. Four primary CMC1 stabilizing muscles were investigated: the extensor pollicis longus, abductor pollicis longus (APL), abductor pollicis brevis, and first dorsal interosseous. Needle electrodes were inserted into each muscle and a fine-wire electrode was inserted into the DRL. The DRL was stimulated at 200 MHz while EMG activities in the muscles were recorded during isometric tip, key, and palmar pinch. Average EMG values were analyzed to compare prestimulus (t 1) with post-stimulus (t 2) activity. Results Poststimulus changes were observed in all 4 muscles and 3 positions tested. During tip pinch we observed mass inhibition with a decrease in all muscle amplitudes. In key pinch we observed a rapid co-contraction response. Rapid inhibitory response of antagonistic musculature was observed during palmar pinch. The APL was the only muscle to react within 20 ms after stimulation. Conclusions We identified CMC1 ligamento-muscular reflexes. The mass inhibition of activity observed during tip pinch indicated a protective ligamento-muscular relation that affects all 4 muscles. The co-contractions observed promote joint stability. The fast response in the APL, coupled with its neuroanatomical proximity to the DRL, indicate a particular role in CMC1 proprioception. Clinical relevance Proper ligamentous support and retained innervation is likely important for adequate joint function; their innate functions ought to be considered when planning surgical or orthotic treatments.
Journal of wrist surgery, Mar 29, 2016
Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) of... more Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ. Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p < 0.05. Results After isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p ¼ 0.004). Conclusion Sectioning of the dorsal ligament group resulted in the greatest dorsoradial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers. Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.
Journal of Plastic Surgery and Hand Surgery
The Journal of Hand Surgery, 2022
International journal of surgery case reports, 2016
Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a benign lesion with a female predomi... more Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a benign lesion with a female predominance and an aesthetically disturbing appearance. Spontaneous remission is not reported and medical treatments proposed so far have shown variable results. We describe a rare case of an extensive variant of NHNA covering almost the entire breasts' surface. At present, only three other reports are present in the literature. Medical treatment proved not completely effective and the patient was also affected by a significant breast asymmetry-hypertrophy. Therefore, NHNA was managed surgically with excision of the areolar affected portions while performing breast reduction-lift. The result was satisfactory and without recurrence of lesions at 5-year follow-up. This case reported favorable outcomes of surgery for NHNA. Reports of success with these procedures are still limited, but the promising results in terms of radicality and aesthetic outcome suggest it should be offered to patients ...
Journal of Wrist Surgery, 2016
Journal of Hand Surgery (European Volume), 2015
Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscu... more Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscular support and joint congruity. We wanted to identify the muscles important in preventing or increasing dorsoradial subluxation of this joint. In ten cadaveric hands, a Fastrak® motion tracking device was used to assess the effects of individual isometric muscle loading on the base of the thumb metacarpal relative to the radius and to the base of the middle finger metacarpal. We found that the first dorsal interosseous muscle caused the least dorsoradial translation and highest distal migration of the base of the first metacarpal, whereas abductor pollicis longus was the primary destabilizer, increasing dorsoradial misalignment. The findings show different impacts of these muscles on joint alignment and stability, which suggests that treatment should be targeted to enhance the action of the primary stabilizing muscle, the first dorsal interosseous muscle.
Journal of Wrist Surgery, 2015
The Journal of Hand Surgery, 2014
Clinical Orthopaedics and Related Research®, 2013
Current Rheumatology Reviews, 2013
Ligamento-muscular reflex patterns following stimulation of a thumb carpometacarpal ligament: an ... more Ligamento-muscular reflex patterns following stimulation of a thumb carpometacarpal ligament: an electromyographic study. Manuscript.
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Papers by Nathalie Mobargha