Zeitschrift fur Kinderchirurgie und Grenzgebiete最新文献

The late results of treatment of camptodactylia are reported and 15 patients are presented. It is shown that early surgery can produce good results. Correction in older patients is more problematical and the results are only symptomatic.

The primary treatment of an injured hand has great influence on later results, and also on secondary measures in reconstruction. In contrast to adults, children show a good healing of distal-pedicle flaps, after removal of fat and sparing the subdermal plexus. The choice of skin replacement must be made under careful consideration of site, function and the possibility of further measures for rehabilitation. Where several structures in the child's hand are injured, good results can be attained by combining an adaptation-osteosynthesis with Kirschner wires, and a plaster cast. Several cases are demonstrated, with examples.

The essential points of the Kleinert technique of primary suture of the flexor tendons are briefly laid out. Even although the success of this method depends especially on the co-operation of the patient, we have been able to obtain very good results, particularly in children. Here, too, we used dynamic splinting in the form of a whole-arm splint, and in the case of very small children, the mother was instructed in the therapy.

The technique of nerve-suturing belongs in modern times to the domain of microsurgery. Without implementing the posibilities offered by microsurgery, nerve-suturing - even directly end-to-end - is obsolete. In order to obtain a sufficient functional end-result, suturing under tension must be avoided at all costs. Knowledge of this has given rise to the common interposition nerve grafts. Even with interposition grafts, no cases of growth-disturbances, including a failure of the nerve to grow or disturbances in function because of growth, have been observed in children. For a good post-op. results, a continual therapy with neurotropic medicaments, physiotherapy and faradisation, and neurophysiological checks on progress made in renervation are absolutely essential.

A 2-year-old child is presented with irregular frequent vomiting leading to a very severe marasmus. Only repeated radiological investigations revealed the hepatodiaphragmatic interposition of the colon. Two years after surgery she has nearly doubled her body-weight.

The importance of close collaboration between the plastic surgeon and the neurologist who is interested in electrophysiological techniques is particularly important in children. Collaboration of the patient may be limited. Electromyographical and electroneurographic investigations may localise the lesion and be relevant to giving a prognosis. The various methods and limitations are briefly discussed.

A 17 year old patient is presented who had aplasia of the radius for clubhand described by Clodius. The ulnar was divided at the wrist and the distal fragment was rotated by 90 degrees. Tendons were elongated by z plasties. Results can be described as satisfactory.

47 children with syndactylia treated over a 12-year period were presented. The multiple Z incision with pedicle flaps is advocated.

Histochemical staining and biochemical assay of acetylcholinesterase (AChE) activity were applied to rectal suction biopsy tissue from patients treated by Z-shaped anastomosis for Hirschsprung's disease. Postoperative AChE activity and AChE/Total ChE (% AChE) in the rectal anterior wall were significantly higher (p < 0.001) than those in the posterior wall. Biochemical AChE activity was well correlative to visual mucosal AChE activity. It is remarkable that AChE activity in the rectal anterior wall after Z-shaped anastomosis was found to be kept at high level for a long period without any relation to the time interval after the operation, the ano-rectal function, and the recto-anal reflex.

A 6-year-old boy is reported who was operated upon with a pre-operative diagnosis of a recurrent right incarcerated inguinal hernia. As green-brown fluid appeared from the suspected hernial sac, a laparotomy was performed which showed a duplication of the ascending colon with a prolongation into the inguinal canal. The duplication and the relative intestinal segment were excised (right-sided) and because of the close relationship between the intestinal wall and the wall of the cyst, and the shared blood supply, an organ procedure was technically not possible.