Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

The increasing number of lymphatic surgery procedures in recent years has led to an increased economic relevance of plastic surgery departments. The high time variance associated with microsurgical LVA procedures makes surgical planning more challenging and hampers optimal capacity utilisation. In addition, there is currently no data on the adequate representation of the surgical costs in the InEK (Institute for the Hospital Remuneration System) matrices of the DRGs to be billed.By analysing a total of 69 patient cases with LVA surgery, the influence of patient-specific and independent parameters as well as the choice of anaesthesia on the incision-suture time was investigated. After breaking down the surgical costs using cost object accounting, the revenue generated was calculated depending on the DRG. A cost-effectiveness analysis of LVA surgeries and benchmarking with other clinics was then performed.Patient-independent parameters such as the surgeon's experience and the number of anastomoses have a significant influence on the duration of the surgery, whereas patient-specific factors such as comorbidities are of minor importance. Regarding the surgical costs incurred in relation to the amounts calculated by InEK, there was a large discrepancy in the reimbursement amounts depending on the DRG billed, with some of the costs found to be inadequately covered. The training costs for LVA operations exceeded €200.The choice of the DRG to be billed has a decisive influence on the economic viability of LVA operations in the German healthcare system. In addition, inclusion or modulation of patient-independent parameters can optimise surgical planning, resulting in a more efficient use of operating room capacity and improved cost-effectiveness. Training costs are not adequately reflected in LVA surgeries.

Purpose: This study aims to compare the clinical and radiological outcomes of three different techniques used in the surgical treatment of ulnar styloid fractures.

Material and method: Ulnar styloid fractures treated surgically between 2012 and 2022 were evaluated retrospectively. There were three groups in the study: Group I (Kirschner wire, N= 19), Group II (tension band, N= 27) and Group III (headless compression screw, N= 25). The Gaulke classification was applied to categorise the fractures. After a follow-up period of at least one year, range of motion, Modified Mayo Wrist Score (MMWS), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH), Visual Analogue Scale (VAS) and grip strength were measured. In addition, radiological union, bone resorption and dorsal subluxation of the DRUJ were evaluated.

Results: There was no difference between the three groups in terms of demographic data. Gaulke type 2 A was more frequently observed in all three groups (47.4%, 74.1%, 64%, respectively). Range of motion (flexion, extension, supination, pronation) was similar in all three groups (p>0.05). QDASH and MMWS were similar in all three groups. Grip strength was significantly lower in Group I than in Group II (p=0.039). Radiological outcomes (nonunion, dorsal subluxation, bone resorption) were similar in all three groups. Implant irritation was significantly higher in Group II (p=0.026).

Conclusion: K-wires, tension band wiring and headless compression screws yield similar clinical and radiological outcomes in the surgical treatment of unstable ulnar styloid fractures. However, the need for secondary surgery is more frequent when a tension band is used.

Level of evidence: Level IV.

Every skin injury leaves a scar with inferior mechanical properties, which can lead to limitations in function and quality of life. Consistent therapeutic support during wound healing can ensure optimal formation of new tissue. The greatest challenge in scar treatment is the dosage of therapeutic interventions: stimuli must meet the requirements of the tissue in its current state. However, excessive strain on the structure must be avoided to enable proper and undisturbed wound healing. Optimal treatment is based on the patient's fundamental conditions and is adjusted to the specific requirements of the healing tissue throughout the phases of wound healing. Continuous monitoring of the healing process, constant adjustment and selection of techniques, and consistent implementation of manual interventions are essential, particularly in the later stages of scar formation. It is crucial to involve patients in the independent treatment and care of scar tissue to increase the time under adequate tension and maintain the tissue in the best possible condition.

Thermal injuries and operating room fires pose significant risks to patients, especially when energy-based devices like monopolar diathermy are used. A study conducted by the FDA over 20 years reported over 3,500 injuries and 178 deaths, mostly caused by burns. The main causes of operating room fires can be explained by the "fire triangle": ignition sources, fuels, and oxidizers. Monopolar diathermy and lasers act as ignition sources, while alcohol-based disinfectants provide fuel. As oxidizers, oxygen and nitrous oxide further increase the risk of fire.This review is based on a literature analysis and case vignettes of patients with thermal injuries. It aims to highlight the severe consequences of such injuries and outline preventive measures.The findings underscore the need for a multidisciplinary approach. Key strategies include reducing oxygen concentration and using alternative disinfectants. Targeted training for the surgical team, along with the use of "Fire Risk Assessment Tools", can substantially improve patient safety.In conclusion, comprehensive risk management, the development of specific protocols, and team training are essential to prevent thermal injuries and sustainably reduce patient risk in the operating room.

Congenital deformities of the female breast pose a unique surgical challenge, requiring an individualized approach, particularly for young patients. In this article, we describe a surgical treatment algorithm evaluated over a 7-year period through a retrospective study, focusing on complication rates and breast anthropometric data.A retrospective cohort study was conducted, including 36 patients followed up for 7±3.2 years. All patients underwent surgery based on the proposed therapeutic algorithm. Postoperative assessments were performed at 1 and 6 weeks and 6 months to 10 years. Clinical data, including complications, Baker grade, ptosis degree, and anthropometric measurements, were collected. Additionally, 3D breast images were taken, and a validated patient-reported quality of life outcome measure (Breast-Q™) was administered.Alloplastic augmentation exhibited a significantly higher complication rate (42%) compared with autologous fat transplantation (7.69%). We observed a mean side-to-side difference in areolar diameter of 0.37 cm for autologous reconstruction and 0.78 cm for alloplastic augmentation. The calculated symmetry index revealed 93% symmetry for both therapeutic approaches. All objective measurement methods demonstrated a lasting, symmetrical therapeutic success in correcting congenital deformities. Long-term patient-reported result satisfaction (Breast-Q™) was 74%. Patients undergoing autologous reconstruction required an average of 2.9 procedures to achieve the desired outcome, compared with 1.3 procedures for alloplastic augmentation.The therapeutic algorithm proved to be valid in terms of complication rates, breast symmetry, nipple-areolar complex (NAC) symmetry, and patient satisfaction. It can be considered for patients with congenital breast deformities. Alloplastic reconstruction should be critically discussed due to its increased complication rate.