Dr. Jean-Claude GUIMBERTEAU, M.D.

CHIRURGIEN PLASTICIEN - PLASTIC SURGEON - FRANCE

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Biography

Jean-Claude Guimberteau is co-founder and former scientific director of the «Aquitany Hand Institute»,1987-2011 and director of research at the «French society of plastic, reconstructive and aesthetic surgery».
He has been an established member French Hand Society (GEM) and of the French society of Plastic and Reconstructive surgery (SOFCPRE).
He was trained in the Hand and Plastic department of the Bordeaux University by distinguished surgeons (Dr AJM. Goumain and Pr J. Baudet) During this surgical training, he was exposed to the philosophies of microsurgery and vascularized composite tissue transfers surgery.
He extended this training (1976) in a fellowship with world-renowned surgeon’s Professor J.M. Converse in New York (USA) and Professor R. Millard in Miami (USA).
Over the following years he compiled his book ‘New Ideas in Hand Surgery”, which introduced innovative concepts in hand anatomy, physiology and secondary flexor tendon repair. These concepts have been revolutionary to hand surgery, and have been endorsed by Hand Surgery legends such as Professors Cl Verdan and Professor H.E. Kleinert.
He has become a pioneer in hand surgery innovating a novel technique for reconstruction of flexor tendons, using vascularized island transfers and he was the first to perform vascularized allotransplants of flexor tendon in 1991.
Much of Jean Claude’s current passion lies in exploring and defining the movement of tissues beneath the skin, using intraoperative endoscopic visualization of living tissue. As a director and producer of many videos on living matter, he has developed a new concept on living tissues and proposed a new paradigm for the development of biological structure in man.

Titles

- 1967 : Nomination à l'Externat en Médecine.
- 1971 : Nomination à l'Internat des Hôpitaux de Bordeaux (Médaille de bronze).
- 1976 : Diplôme de Médecine Tropicale.
- 1977 : Nomination Chef de Clinique des Hôpitaux en Chirurgie.
- 1977 : Docteur en Médecine No 33 1 05143 3 : Thesis : Transfert microchirurgical libre de péroné. Microsurgical Fibula free transfer.
- 1979 : Qualification en Chirurgie Générale.
- 1980 : Qualification en Chirurgie Plastique et Reconstructrice.
- 1980-1992 : Attaché de consultation en Chirurgie Plastique, Chirurgie de la Main à l'Hôpital des Enfants (Service du Professeur Bondonny).
- 1984 : Président Fondateur de l'Association Urgence Main et Face, Bordeaux.
- 1988 : Membre fondateur de l'Institut Aquitain de la Main.
- 1993 : Président SOS Mains Aquitaine.
- 1997-2004 : Membre des bureaux de chirurgie de la main et de microchirurgie de la Société Française de chirurgie plastique, reconstructrice et esthétique.
- 1999-2004 : Responsable de la cellule Recherche à la Société Française de chirurgie plastique, reconstructrice et esthétique.
- 2001-2004 : Responsable du Pôle d'orientation des urgences spécialisées en chirurgie de la main. POSU Urgences St Martin.
- 2003-2004 : Membre du Comité “Tendon surgery” à la «International Federation Surgery Hand»
- 2004 : Coordinateur de la Fédération des services urgences Main pour la Région Aquitaine.
- 1997-2007 : Membre des bureaux de chirurgie de la main et de microchirurgie de la Société Française de chirurgie plastique, reconstructrice et esthétique. SOFCPRE.
- 1999-2011 : Responsable de la cellule Recherche à la Société Française de chirurgie plastique, reconstructrice et esthétique
- 2001-2011 : Responsable du Pôle d’orientation des urgences spécialisées en chirurgie de la main. POSU Urgences St Martin.
- 2003-2007 : Membre du Comité Tendon surgery à la «International Federation Surgery Hand».
- 2003-2007 : Coordinateur de la Fédération des services urgences Main FESUM pour la Région Aquitaine
- 2007 : Election Membre de l’Académie Nationale de chirurgie.
- 2007-2011 : Election au poste de secrétaire général de la Fédération Européenne des services d’urgence de la main : FESUM.
- 2008 : Nomination Membre de la Haute Autorité de Santé
- 2010 : Election au poste de 2éme vice président de la SOFCPRE.
- 2011 : Nomination au poste de 1er vice président de la SOFCPRE.
- 2012 : Nomination au poste de président de la SOFCPRE.

Academic societies

- 1977 : Membre de la Société de Chirurgie du Sud-Ouest.
- 1978 : Membre de la Société Française de Chirurgie Plastique et Reconstructrice.
- 1978 : Membre du Groupe pour l'avancement de la Micro-Chirurgie (G.A.M.).
- 1986 : Membre du Collège Français d'enseignement de la Chirurgie Plastique, Reconstructrice et Esthétique.
- 1988 : Membre étranger de la Société Italienne de Chirurgie de la Main.
- 1990 : Membre étranger de la Société Suisse de Chirurgie de la Main.
- 2003 : Membre titulaire de la Société Française de Chirurgie de la Main.
- 2004 : Membre du Collège Français d'enseignement de la Chirurgie de la Main.
- 2007 : Membre de l’Académie Nationale de Chirurgie.

Basic ideas

Dr Guimberteau has dedicated 20 years of research into the organisation of living matter with the aid of his endoscope and filming of live human tissue environments. Through simple surgical observations he had discovered complex structures under the skin, and has attempted to explain the anatomy, physiology and pathophysiology of the sliding structures, and its role in lubrication, protection, water, fat and vascular distribution.
This "microvacuolar system" of connective tissue has long been neglected and has a unique arrangement of collagen fibrils within a proteoglycan gel which has made it difficult to study as dehydration renders it hard to see. Dr Guimberteau has attempted to explain this chaotic patterning with observations from our surroundings and natural patterns in biology.

The advent of endoscopic surgery has added a new dimension to these observations allowing us to have a new magnified and moving perspective on living tissue. These concepts have been deduced by compiling hundreds of intraoperative images and video.

These observations have led to a greater philosophical question of how is living matter organized, does this "microvacuolar system" simply connect organs, or is it the constitutive tissue in which the organs are developed ?
Step by step, the concept of a multifibrillar structural organisation has emerged.
The concepts begin by observations made on the skin surface. The topographic patterning on the epithelium at high magnification is composed of many polygonal shapes that deform and recoil to facilitate movement. Though to the dermis we begin to greater collagenous structures, in a “basket weave” conformation which gives the tissue its mechanical properties of elasticity, tensile strength and durability. Beneath the skin, there are many defined anatomical structures but between them, the connective tissue has no conceivable order. Instead, there is a completely disorganised network of collagen fibers with a diversity of shapes and a combination of fractal and chaotic patterns.
The continuity of fibres throughout the body and show how adjacent structures can move independently in different directions and at different speeds while maintaining the stability of the surrounding tissues. The mechanism for doing so lie in the fractal patterning within the connective tissues.
The polyhedral structures created by the fluid air interface and extra cellular matrix produces a tissue with a unique characteristics which has been termed the Multimicrovacuolar Collagenic Absorbing System, but may simple be known as "the microvacuolar system".
It can be distended or compressed, appear to divide, and merge with other fibres, and hence can rearrange themselves to accommodate a number of external mechanical forces. This order allows tissues within it to house a complex vascular network which can dynamically change with the movement of tissues without encountering shearing forces.
The hydrophillic nature of the connective tissues gives it a gel like characteristic which offers an infinite potential of movements.
The precise biology of this tissue is yet to be fully defined and understood but may hold the key to understanding how our tissues develop, why our tissues sag as we age and how arthritis affects our movements.

To begin to unravel these concepts, one has to grasp the complexities of fractal patterning and non-linear dynamical systems which is used to describe objects that are apparently disordered, however there is an underlying order in apparently random pattern.

In conclusion to these works, he has developed a concept of global dynamics and continuous matter pushing back ideas of virtual spaces or separate layers.

He has seen that connective tissue is not only a tissue for connexion between different organs, it is actually the constitutive tissue, the tissue that makes the frame and gives organised and structural existence to the body. Form is maintained and preserved thanks to this interior fibrillar architecture, in which different cellular specificities are embedded.
He has challenged the paradigm that the anatomy of living tissues is composed of virtual spaces or separate layers and replaced it with the notion that our bodies function as one dynamic tissue continuum.

He has revealed the morphodynamic nature of the fibrils of the connective tissue under the influence of intracorporeal physical forces, subject which has remained for too long in the dark.
He has explained that sliding systems are a real firework display of movements of fibrils, intersecting, overlapping and substituting. There is, however, an apparent underlying logic.

He has opened a window into a strange world of fibrillar chaos and unpredictable behaviour, Fascia could be considered as the fractalized tensional architectural network of the human body whatever the level, from the molecule to the surface of skin.
The body seems to be an ideal mesh, made of fibres, fibrils and micro-fibrils, and micro-vacuolar spaces with a structural rationalism allowing us to associate molecular physicochemical biodynamics with quantum physics.

Therefore, living form can be described and interpreted.
A real structural ontology can be worked out through a basic functional unit, which is the micro-vacuole, the micro-volume responsible for the form and the dynamics.
The world lying beneath the skin remains to be discovered but from now on, nothing can be accounted for without considering this fractally organised and chaotic tissue architecture, vector of that most beautiful of efficiencies… life