GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW最新文献

We report the case of a 65-year-old male patient with massive epigastric pain of sudden onset and vomiting due to an organoaxial volvulus of the stomach. We comment on the surgical management in our case and discuss etiology and therapeutic options of this rare entity.

Vater-Pacini neuromas are rare causes of severe pain in the phalanges. The cause of this change in the tactile corpuscles is unknown. A traumatic cause has been plausibly demonstrated, at least in some cases. Here, the rare occurrence of a Vater-Pacini neuroma in a patient with neurofibromatosis type 1 is reported. The discussion addresses the difficulties of terminology and current diagnostic procedures for differentiating small nodular masses of the palm and digits. The surgical treatment leads to rapid relief of the symptoms.

Aim: To share our experience with the management of Fournier gangrene (FG) using the bagging technique of the testes, and to highlight the importance of implementing a multidisciplinary approach in managing FG. Case presentation: A 58-year-old male with type 2 diabetes mellitus (DM) was brought to the emergency department (ED) with necrotizing fasciitis involving the genitalia; he was managed in the ED with Intravenous (IV) fluid resuscitation and IV antibiotics. The surgical team was consulted and multiple debridement procedures were done. Healthy granulation tissue was formed within one month of the serial debridement. A split-thickness skin graft using bagging technique of the testes and vacuum-assisted closure (VAC) were applied. The patient was reassessed one year following presentation, and a result with a near normal appearance was achieved with complete preservation of functional outcome. Conclusion: FG is a type of necrotizing fasciitis that could be managed either conservatively with IV antibiotics and/or hyperbaric oxygen, or surgically by debridement and applying VAC. In our case, the testes were debrided and bagging technique of the testes was used. It's believed that with this technique, the overall cosmetic and functional results are superior.

Nasofrontal fistulas correspond to the persistence of an abnormal communication of embryological origin between the deep layer of the skin and the central nervous system (CNS). They can rarely be associated with a dermoid cyst and be revealed by a locoregional infection, and especially neuromeningeal infections can be serious. The treatment is mainly surgical by performing a total excision of the cyst and the repair of defects. The authors report the case of an 18-month-old infant operated for a dermoid cyst revealed by a nasofrontal fistula. They insist on the characteristics of this pathology in order to establish a diagnosis and an early treatment to avoid the complications that can be heavy in certain cases. They describe the steps of nasofrontal reconstruction by a small flap taken from the outer table of the frontal bone with better esthetic results.

Objective: Cervical bone fractures describe a predominant trauma in the elderly. With demographic change, prone patient positions might create further stress on personnel resources. Therefore, the aim of this study was to conduct an age-related analysis of pre- and intraoperative process times in patients with cervical fractures. Methods: We reviewed all schedules with cervical spine surgery performed at a tertiary hospital. Two different operative patient positions were specified: prone and supine. We retrospectively analysed three study groups: comparison group (group 1: ≤59 years of age), old patients (group 2: 60-79 years), and very old patients (group 3: ≥80 years). We recorded date and kind of surgery, biometric data, and process times by screening recordings of internal software programs (COPRA^® and SAP 710^®). Group comparisons were conducted using the Kruskal-Wallis test with Dunn's post hoc test and Bonferroni correction, Pearson's chi-square test, and the Mann-Whitney U test, as required. Results: 330 patients (202 male; 128 female) were analysed. The number of patients in the resulting age-dependent groups 1-3 were n=102, n=123, and n=105, respectively. Patients of increasing age and in supine position showed a continuous increase in the time needed for anaesthesia induction (mean between 4 and 8 minutes (p<0.05). When compared to patients in supine position, this time further increased on average by 6 minutes (p<0.05) in old but prone patients. In old and very old patients, getting a patient into a prone position was associated with a time demand between 10 and 12 minutes (p<0.01), respectively. While time for surgery age-dependently decreased in patients that were supine positioned (p<0.001), surgery time was prolonged between 34 and 104 minutes (p<0.05) in patients that were prone. Conclusion: With prone position both anaesthesia-controlled and surgical-controlled times extended in patients of increasing age. With regard to demographic change, this aspect should be considered for future revenue calculations in flat-rate remuneration systems.

Introduction: Human fingertips are able to regenerate soft tissue and skin after amputation injuries with excellent cosmetic and functional results when treated with semiocclusive dressings. Despite bacterial colonizations, proceeding infections are not reported with this management. The underlying mechanisms for this form of regenerative healing as well as for the resilience to infections are not known. Due to the lack of mechanical protection, the leakage of maloderous woundfluid and the sometimes challenging application, conventional film dressings have their problems, especially in treating young children. We therefore treated selected patients with a novel silicone finger cap with an integrated wound fluid reservoir that enables atraumatic routine wound fluid aspiration. Methods: We report on 34 patients in between 1 and 13 years with traumatic fingertip amputations primarily treated with occlusive dressings. 12 patients were treated with a novel silicone finger cap. We summarized clinical data for each patient. This included photographs and microbiological results from wound fluid analyses, whenever available. Results: The results of both, conventional film dressing and silicone finger cap treatment, were excellent with no hypersensitivity and no restrictions in sensibility and motility. Even larger pulp defects were rearranged in a round shape and good soft tissue coverage of the distal phalanx was achieved. Nail deformities were not observed. We detected a wide spectrum of both aerobic and anaerobic bacteria in the wound fluids but infections were not observed. Epithelialization times did not differ significantly and no severe complications were seen in all primarily conservatively treated patients. Conclusion: This study provides preliminary data demonstrating that the treatment with the silicone finger cap leads to excellent clinical results in wound healing. Interestingly, the wounds were colonized with a wide range of bacteria including species that may cause wound infections. However, we saw no proceeding inflammation and the regeneration was undisturbed. In the future, the efficacy of this new management should be evaluated in randomized, controlled clinical trials to confirm the results under standard conditions and get more insight into the role of the wound microbiome as well as other factors that may promote regeneration. The aspirable Reservoir of the finger cap will enable easy atraumatic sampling of wound fluids both for diagnostic and for research purposes as well as possibly allowing direct administration of pro-regenerative drugs in the future.

Neurofibromatosis type 1 (NF1) is a tumor predisposition disease. Multiple neurofibromas are among the characteristic tumors of NF1. The report describes the diagnosis and treatment of a large spinal neurofibroma in a NF1 patient. The tumor showed a striking pigmentation and was diagnosed as pigmented (melanotic) neurofibroma. The distinction between this rare tumor variant and other pigmented tumors, especially malignant melanoma, is of primary importance.

Infection of donor sites in split-thickness skin grafts is one of the complications of skin transplantation. Nutrition status and associated diseases play important roles in healing of donor sites. There are different ways used to treat infected donor sites. Water-filtered infrared-A (wIRA), as a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface, can improve the healing of acute and chronic wounds both by thermal and thermic as well as by non-thermal and non-thermic effects. Water-filtered infrared-A (wIRA) increases tissue temperature, tissue oxygen partial pressure and tissue perfusion. These three factors are decisive for a sufficient supply of tissue with energy and oxygen and consequently also for wound healing and infection defense. This was confirmed in a case with a late severe healing disturbance of the donor sites after skin transplantation.

Introduction: Infection of the knee joint after primary total knee arthroplasty is a serious complication. In this work, we would like to evaluate the mid-term results after two-stage revision of total knee replacement in periprosthetic infection using dynamic spacer, in particular with regard to the function of the knee joint after reimplantation. Patients and methods: In this retrospective study, we included patients who were treated in our clinic between 2005 and 2013 due to infection of the knee after total knee arthroplasty. All patients included have had a mobile antibiotic-coated cement spacer implanted after surgical debridement and removal of the components of total knee replacement. Subsequently, reimplantation of total knee replacement was performed when no clinical or paraclinical signs of infection were found. We analyzed all included cases for potential reinfection, examined the range of motion of the knee joint and evaluated the Merle d'Aubigné-Postel score. Statistical evaluation was performed with SPSS 24.0. Results: This study group contains 16 patients (9 women and 7 men) with an average age of 72.0 ± 8.3 years. All patients were followed up for at least 6 months with an average follow-up of 22.5 ± 16.6 months. In all patients a pathogen was isolated intraoperatively during the first-stage surgery (explantation of the knee). Staphylococci were detected in 94% of the cases, streptococci in only one patient. Reimplantation was carried out after 6.2 ± 5.2 months. The average knee flexion in the group of patients without relapse of infection was 103.3° ± 17.1°. Only 3 patients showed extension deficit of max. 20°. The Merle d'Aubigné-Postel Score was 14.4 ± 1.9. Conclusion: Two-stage surgery of total knee replacement with the use of a mobile spacer has its high value in the treatment of periprosthetic infections. The mobile spacers contribute to an advantageous range of motion of the knee joint after reimplantation of a total knee endoprosthesis. However, further studies are required that compare the results after using mobile or static spacer, but with the inclusion of homogeneous patient collective.

Background: Fournier's gangrene is a necrotizing fasciitis caused by mixed aerobic and anaerobic bacteria and results in loss of skin and subcutaneous tissue in the perineal area. Coverage of testis varies from closure of the defect primarily, burying inside the thigh, using the remnants of the scrotum for tissue expansion and coverage by flaps. In this manuscript, scrotal advancement flaps and pudendal thigh flaps were used for coverage of the testis unilaterally or bilaterally according to the size of the defect following Fournier gangrene. Patients and methods: From June 2015 to March 2017, twelve cases were admitted to our department. The patients' ages ranged from 37-59 years and they all had suffered from Fournier's gangrene in the perineal area. Results: Of the twelve cases, two cases showed penile involvement. A skin graft was used for coverage of the penile shaft with excellent take. Four cases were closed primarily. This was applied to cases where loss of skin was less than 50%. The rest of the cases were reconstructed by pudendal thigh flap. The reconstructed cases were covered by bilateral pudendal thigh flap (4 cases) and unilateral pudendal thigh flap (4 cases). The follow-up extended up to 16 months. Conclusion: Scrotal advancement flap was suitable for small and medium size defects due to the elasticity of the scrotal skin. Pudendal thigh flap was efficient for the reconstruction of large defects of the scrotum.