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Bad Essen, Germany

Steinau H.U.,University of Duisburg - Essen | Farzaliyev F.,University of Duisburg - Essen | Stricker I.,Ruhr University Bochum | Hauser J.,Plastische Chirurgie | Podleska L.E.,University of Duisburg - Essen
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2015

Sarcomas of the hand and wrist are rare malignancies, which should be referred to high-volume comprehensive cancer centres providing multidisciplinary treatment options. The tumour board should propose patient-oriented oncological pathways as well as sophisticated hand and plastic reconstructive procedures. In Addition, isolated limb perfusion with TNF-alpha and melphalan is likely to lead to preoperative tumour shrinkage allowing for R0 resection in sano. Our clinical results in long-term survivors demonstrate reduced amputation rates and salvage of basic hand function when a risk-adapted treatment rationale is applied. © Georg Thieme Verlag KG Stuttgart · New York. Source

Bueschges M.,Universitatsklinikum Schleswig Holstein Campus Lubeck | Ottomann C.,Universitatsklinikum Schleswig Holstein Campus Lubeck | Mauss K.,Universitatsklinikum Schleswig Holstein Campus Lubeck | Muehlberger T.,MCZ | Bruck J.C.,Plastische Chirurgie
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2013

Pirogow's amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers numerous advantages for the patient, such as the ability to stay mobile without the use of a prosthesis, it is rarely performed (0.1% of all lower limb amputations). The results of the operations on 20 patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score), and these results were then compared to those of 20 patients who underwent lower leg amputation. Using a point system the criteria pain, functional and radiological assessment, difference in leg length, and mobility without prosthesis were recorded and evaluated. 65% of those questioned who were amputated following the Pirogow method indicated an excellent or very good result, in the control group 60% of those having undergone a lower leg amputation responded similarly, indicating an excellent or very good result. In 30% in the Pirogow group in contrast to 20% after lower leg amputation postoperative complications lead to a revision-operation. In patients suffering from diabetes or restricted perfusion of the lower extremity an amputation at the level of the ankle has to be considered critically keeping the necessity of a revision-operation in mind. However, if it can be carried out successfully, the benefits of Pirogow-amputation are found in the significantly reduced difference in leg length and the increase in mobility without prosthesis. Source

Zschock-Holle A.,Allgemeinmedizin | Reik M.,Plastische Chirurgie | Wolfle O.,Kliniken des Main Taunus Kreises GmbH | Sauerbier M.,Abteilung fur Plastische
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2015

Background: Goal of the present study was the evaluation of clinical and radiological results after treatment of the first carpometacarpal joint by trapezium resection and implantation of a Swanson silicone prosthesis by means of a retrospetive study. However, up to now, only a few long-term data for this surgical technique are available. Methods and Patients: Retrospectively the results of 100 trapezium resections in 72 patients with subsequent joint replacement by a Swanson silicone prosthesis have been followed up over 8.6 years on average. Besides the range of motion, the strengh in grip, tip pinch and key pinch were measured. The quality of pain was determined using a visual analogus pain scale from 1-10. The postoperative subjective satisfaction of patients was recorded as well as the DASH, Mayo, modified Wrist and Krimmer scores. In follow-up X-ray controls, subluxations of the silicone implants as well as bony abnormalities were evaluated. Results: The postoperative range of motion of the trapeziometacarpal joint in radial abduction was measured with 52° and at palmar abduction with 39°. The average grip strength amounted to 16.5kg. This represented 80% of the value of the contralateral side. In tip pinch the force value was 3.3 kg, corresponding to 70% of that of the opposite side and in key pinch, it was 3.5kg, corresponding to 71% of the healthy contralateral side. The DASH score was recorded with 22.5 points. Postoperative pain symptoms on the visual analogue pain scale were recorded at 2.4 points. The majority of the patients were satisfied or very satisfied after the surgical treatment. In X-ray controls, subluxations of the silicone implants could be detected in 54 cases (61.4%) as well as bony abnormalities in 41 cases (46.6%). However, there was no correlation between the radiological findings and patient satisfaction. Conclusion: Trapezium resection and joint replacement with a silicone prosthesis achieves good results. However, the high number of radiographic subluxations of the prothesis and bone abnormalities as a cause of foreign body reactions limits these results. Therefore, despite the good clinical findings, this method will not been conducted any more in our patient population. © Georg Thieme Verlag KG Stuttgart New York. Source

Ottomann C.,Zentrum fur Schwerbrandverletzte mit Plastischer Chirurgie Unfallkrankenhaus Berlin | Rapp M.,Klinik fur Orthopadie | Bruck J.C.,Plastische Chirurgie | Hartmann B.,Zentrum fur Schwerbrandverletzte mit Plastischer Chirurgie Unfallkrankenhaus Berlin
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2015

The calculation of REC forms the basis of expert opinions for the purposes of making accident insurance assessments after an occupational accident or an accident suffered en route while travelling to or from the workplace. The estimation of REC is based on a procedure quoted in the 1995 “Jahrbuch der Versicherungsmedizin” (Yearbook of Insurance Medicine) using a form developed by Henkel von Donnersmarck and Hoerbrand. The overall estimation of damages resulting from the accident comprises 3 main components, namely the functional impairment, the assessment of local findings and the resulting somatic and vegetative complaints. The criteria for all 3 components are nevertheless imprecise and open to a great deal of interpretation on the part of the evaluator, leading to a highly variable and subjective overall assessment of REC. The new REC form includes a modified factor-based categorisation of the scar quality and the localisation, so that assessment can now be carried out in a differentiated manner. Visible, stigmatising areas such as the neck are provided with their own Q values. The pigmental and textural alterations describing the scar quality are now more precisely defined. Considering the complexity of the somatic and vegetative alterations, more precise (objective) assessments can now be derived. The new REC form increases the validity and transparency of post-thermal trauma REC assessments for the purposes of making statutory accident insurance assessments. Copyright © 2015, Georg Thieme Verlag KG. All rights reserved. Source

Ottomann C.,Zentrum fur Schwerbrandverletzte mit Plastischer Chirurgie | Rapp M.,Klinik fur Orthopadie | Bruck J.C.,Plastische Chirurgie | Hartmann B.,Zentrum fur Schwerbrandverletzte mit Plastischer Chirurgie
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2015

The total REC (reduction in earning capacity) after a thermal trauma is usually assessed using an appraisal form for burns victims, initially developed by Hoerbrandt and von Donnersmarck (1995). The criteria for functional impairment, local findings and vegetative-somatic complaints are somewhat imprecise given the broad scope of interpretation which the evaluator can employ in making an appraisal. This means that the overall appraisal of REC is subjective on the part of the evaluator. In addition, one can only calculate an overall REC of at most 40% from local findings and vegetative-somatic symptoms, even in patients with extensive large area burns. Considering these points we investigated the dependency of the results on the evaluator as well as the limited validity of the appraisal form originally developed by Hörbrand and Donnersmark. © 2015 Georg Thieme Verlag KG Stuttgart. New York. Source

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