Hand and Reconstructive Surgery

Frankfurt am Main, Germany

Hand and Reconstructive Surgery

Frankfurt am Main, Germany
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Bhat W.A.,Hand and Reconstructive Surgery | Davis C.R.,Frenchay Hospital | Mather D.P.,Hand and Reconstructive Surgery
Techniques in Hand and Upper Extremity Surgery | Year: 2015

Bruner's incision has provided surgical exposure for elective and traumatic hand procedures since 1973.We present a modification of the stay stitch-the Wraparound stitch-using a single suture and single tie. The technique is safe, simple and cost effective, and is the authors' preferred method of surgical exposure during hand surgery. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Ensat F.,Hand and Reconstructive Surgery | Babl M.,Hand and Reconstructive Surgery | Conz C.,Hand and Reconstructive Surgery | Rueth M.-J.,Hand and Reconstructive Surgery | And 5 more authors.
Microsurgery | Year: 2012

The anterolateral thigh (ALT) flap has become a workhorse in reconstructive surgery of the head and neck region and the extremities. However, its inconsistent vascular anatomy and frequent intramuscular course of perforators often cause difficulties during the dissection of this versatile flap. Hence, reliable preoperative perforator mapping and identification of vascular anomalies may render the raising of the flap easier and safer. The aim of this study was to evaluate the use of Color Duplex sonography and whether it allows the distinction between septocutaneous and musculocutaneous perforators. For this purpose, the thighs of 13 patients undergoing reconstruction with ALT flaps were examined preoperatively, and results were compared to intraoperative findings. A total of 30 perforators could be detected preoperatively, of which 29 were confirmed during flap dissection. Preoperative Color Duplex sonography correctly predicted the course of all perforators as either running through the vastus lateralis muscle or the intermuscular septum. In our investigations, Color Doppler sonography had a 96.7% positive predictive value and a 96.7% true positive rate in detecting perforators. Color Duplex sonography is a highly reliable tool in the preoperative assessment of ALT flaps. Localization and course of perforators can be determined accurately and vascular anomalies can be identified. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. Copyright © 2012 Wiley Periodicals, Inc.

Mutschler M.,Cologne Merheim Medical Center | Nienaber U.,Surgery Academy | Brockamp T.,Cologne Merheim Medical Center | Wafaisade A.,Cologne Merheim Medical Center | And 5 more authors.
Resuscitation | Year: 2013

Aim: The aim of this study was to validate the classification of hypovolaemic shock given by the Advanced Trauma Life Support (ATLS). Methods: Patients derived from the TraumaRegister DGU® database between 2002 and 2010 were analyzed. First, patients were allocated into the four classes of hypovolaemic shock by matching the combination of heart rate (HR), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) according to ATLS. Second, patients were classified by only one parameter (HR, SBP or GCS) according to the ATLS classification and the corresponding changes of the remaining two parameters were assessed within these four groups. Analyses of demographic, injury and therapy characteristics were performed as well. Results: 36,504 patients were identified for further analysis. Only 3411 patients (9.3%) could be adequately classified according to ATLS, whereas 33,093 did not match the combination of all three criteria given by ATLS. When patients were grouped by HR, there was only a slight reduction of SBP associated with tachycardia. The median GCS declined from 12 to 3. When grouped by SBP, GCS dropped from 13 to 3 while there was no relevant tachycardia observed in any group. Patients with a GCS=15 presented normotensive and with a HR of 88/min, whereas patients with a GCS<12 showed a slight reduced SBP of 117. mmHg and HR was unaltered. Conclusion: This study indicates that the ATLS classification of hypovolaemic shock does not seem to reflect clinical reality accurately. © 2012 Elsevier Ireland Ltd.

Hashmi F.R.,Warwick Hospital | Mayr E.,Hand and Reconstructive Surgery
European Journal of Orthopaedic Surgery and Traumatology | Year: 2016

Introduction: The objective of this study was to assess the clinical outcome of displaced proximal humerus fracture treated with a new locking blade nail. Materials and methods: This prospective study included a series of 92 patients with acute fracture of the proximal humerus treated in one hospital level I trauma centre with locking blade nail between December 2010 and December 2013. According to the Neer classification, all fractures were two- to four-part fractures. Age adopted Constant score, DASH and visual analogue scores were used as outcome measures. Results: A total of 92 patients were enrolled in the study. However, 29 patients were excluded due to loss to follow-up and death. Ultimately, 63 patients were available for final follow-up and data analysis. The mean duration of follow-up was 22 months (range 16–48 months). On average at 1 year, all fractures had united. The mean weighted Constant score was 84.2 % and the median disabilities of the arm, shoulder and hand (DASH) score was 26, the range of elevation was 115 and range of abduction was 97. The head shaft angle was 130, and pain visual analogue was 1.6. We found that 5 of the 63 patients (8 %) demonstrated complications. Two patients (3 %) displayed secondary displacement and require device removal. Two patients (3 %) had impingement due to prominent metal work, and one patient had a superficial wound infection which was treated with a course of antibiotics. Conclusion: Our study shows excellent results with new locking blade nail for displaced proximal humerus fractures. We think the locking blade nail offers stiff triangular fixation of the head fragment and support of the medial calcar region to prevent secondary varus collapse. Level of evidence: III. © 2016 The Author(s)

Wirbel R.,Hand and Reconstructive Surgery | Hermans K.,St Elisabeth Hospital
African Journal of Paediatric Surgery | Year: 2014

Background: The surgical management of chronic osteomyelitis in children is still challenging in developing countries. This study analysed the extent of the disease and the therapeutic regime.Subjects and Methods: This was a retrospective study in two primary health care hospitals from January 2009 to December 2013, 27 children (20 males and 7 females, mean age 7 years) admitted from developing countries who were treated for chronic osteomyelitis. Localization, duration of the disease, extent of the osseous involvement, spectrum of germs, number of previous and required surgical procedures and duration of hospital stay are reported.Results: A total of 16 cases had haematogenous and 11 cases post-traumatic aetiology. The mean duration of the disease was 18 months. On average, three (range, 1-12) previous surgical procedures were performed. The affected bones were: Tibia in 11, femur in 8, forearm in 6 cases, spine and humerus each in 1 case. Staphylococcus aureus was the responsible germ in 75%. On average, four (range, 2-8) surgical procedures were required. Osseous stabilizations were necessary in 17, plastic soft tissue reconstructions in 8 cases. In three cases with metaphyseal/diaphyseal defect, bone transfers had to be performed (2 × fibula-pro-tibia, 1 × rib for radius). The mean hospital stay took 8 (range, 4-20) weeks. Three local recurrences occurred within 3 months, all could be cured surgically.Conclusions: The surgical treatment of chronic osteomyelitis in children requires a radical osseous debridement. The knowledge of different plastic-surgical procedures is necessary to reconstruct osseous and/or soft tissue defects.

Herold C.,Hand and Reconstructive Surgery | Gohritz A.,Hand and Reconstructive Surgery | Meyer-Marcotty M.,Hand and Reconstructive Surgery | Steiert A.,Hand and Reconstructive Surgery | And 3 more authors.
Journal of Reconstructive Microsurgery | Year: 2011

The aim of this study was to evaluate the relevant conditions for safe free flap transfers. The authors retrospectively studied the data from 150 patients who received free flaps at a single institution. Many parameters were analyzed to reveal if there was a correlation with respect to surgical or medical complications. Regarding safety of free tissue transfer, we found a worse prognosis in flaps where a revision of the microanastomosis had to be performed. Platelet count and leukocyte count had an impact on the prognosis. Patients older than 60 years did not have an increased rate of surgical complications. Apart from active osteomyelitis, the presence of comorbid conditions did not significantly impair the outcome of flap transfer, although smoking and diabetes correlated with minor surgical complications like wound breakdown or hematoma, respectively. Besides one case of lethal heart failure of an octogenarian patient, no severe medical complications occurred in this series of patients. Microvascular free tissue transfer is not significantly impaired by age and most comorbidities. Osteomyelitis as well as elevated leukocytes and lowered platelets may increase the complication rate and worsen the surgical prognosis. Smoking and diabetes might prolong the hospital course of the patients. Copyright © 2011 by Thieme Medical Publishers, Inc.

Jakubietz R.G.,University of Würzburg | Jakubietz D.F.,Hand and Reconstructive Surgery | Gruenert J.G.,Hand and Reconstructive Surgery | Schmidt K.,University of Würzburg | And 2 more authors.
Microsurgery | Year: 2010

Introduction. Soft tissue defects exposing the Achilles tendon are challenging. Local perforator flaps represent a valuable option gaining increasing popularity. Despite preoperative planning an adequate perforator cannot always be found intraoperatively. The free peroneal artery perforator flap can serve as a back-up option limiting the donor site morbidity to the same extremity without sacrificing major vessels or nerves. Methods. Nine patients with soft tissue defects exposing the Achilles tendon were treated with local perforator flaps, seven were scheduled for 180° propeller flap coverage after Doppler-ultrasound examination. However, in two patients (22%) no adequate perforators were found intraoperatively. As the perforators for the free peroneal artery perforator flap were routinely mapped out, this flap was harvested for microsurgical reconstruction. Results. One patient with a 180° propeller flap developed a partial flap necrosis, another patient developed superficial epidermolysis, both requiring skingrafting. No complications were seen with free tissue transfer. Conclusion. Pedicled perforator flaps as propeller flaps add options to the armamentarium of microsurgeons. Despite thorough preoperative planning the surgeons must be prepared to perform a different method of reconstruction if inadequate vessels are encountered. To limit additional donor site morbidity, local options are preferred. The free peroneal artery perforator flap represents a good option as it matches the original tissue properties closely. The complication rate of propeller flaps in this series is tolerable. Propeller flaps should therefore be considered an alternative but not as a replacement of local fasciocutaneous flaps. © 2010 Wiley-Liss, Inc.

Vogt P.M.,Hand and Reconstructive Surgery | Herold C.,Hand and Reconstructive Surgery | Rennekampff H.O.,Hand and Reconstructive Surgery
Aesthetic Plastic Surgery | Year: 2011

A case of autologous fat transplantation for labia majora augmentation after ablative surgery is presented. The patient reported pain and deformity of the left labium majus after resection for Bowen's disease. The symptoms had not been solved by classic plastic surgical reconstructions including a pudendal thigh fasciocutaneous flap. Use of autologous fat transplantation facilitated an improved aesthetic result while preserving residual sensation to the external genitalia and improving symptoms of mucosal exposure and dryness. © 2011 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery.

Kuhbier J.W.,Hand and Reconstructive Surgery | Weyand B.,Hannover Medical School | Radtke C.,Hannover Medical School | Vogt P.M.,Hannover Medical School | And 2 more authors.
Advances in Biochemical Engineering/Biotechnology | Year: 2010

While bone marrow-derived mesenchymal stem cells are known and have been investigated for a long time, mesenchymal stem cells derived from the adipose tissue were identified as such by Zuk et al. in 2001. However, as subcutaneous fat tissue is a rich source which is much more easily accessible than bone marrow and thus can be reached by less invasive procedures, adipose-derived stem cells have moved into the research spotlight over the last 8 years. Isolation of stromal cell fractions involves centrifugation, digestion, and filtration, resulting in an adherent cell population containing mesenchymal stem cells; these can be subdivided by cell sorting and cultured under common conditions. They seem to have comparable properties to bone marrow-derived mesenchymal stem cells in their differentiation abilities as well as a favorable angiogenic and anti-inflammatory cytokine secretion profile and therefore have become widely used in tissue engineering and clinical regenerative medicine. © Springer-Verlag Berlin Heidelberg 2010.

Sahin H.,Hand and Reconstructive Surgery | Sahin H.,RWTH Aachen | Tholema N.,Hand and Reconstructive Surgery | Petersen W.,Martin Luther Krankenhaus | And 2 more authors.
Journal of Orthopaedic Research | Year: 2012

Recent studies reveal an important role of vascular endothelial growth factor (VEGF)-induced angiogenesis in degenerative tendon diseases. The way how VEGF influences mechanical properties of the tendons is not well understood yet. We here hypothesized that tendinopathy results in a hypoxia-mediated stimulation of VEGF and that the mechanical stability of the tendon is impaired in an angiogenic process by VEGF-induced matrix metalloproteinases (MMPs). A modified in situ freezing model of patellar tendon was used to create a tendinopathy. 0, 7, 14, and 28 days post-surgical animals were sacrificed and patellar tendons were dissected for biomechanical and immunohistochemical analysis. Native tendons were used as controls. Immunohistochemical staining revealed a peak in HIF-1α stabilization immediately after surgery. Both VEGF and MMP-3 were increased 7 days after surgery. Angiogenesis was also abundant 7 days after surgery. In contrast, biomechanical stability of the tendon was decreased 7 days after surgery. The current results reveal a time-dependent correlation of HIF-1/VEGF-induced and MMP-3-supported angiogenesis with decreased biomechanical properties during tendon healing. The therapeutical modulation of neoangiogenesis by influencing the level of VEGF and MMP-3 might be a promising target for new approaches in degenerative tendon diseases. © 2012 Orthopaedic Research Society.

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