Zeitschrift fur plastische Chirurgie最新文献

Pedicle flaps from the chest or abdomen are still most suitable to cover large skin and soft tissue defects on the upper extremity. Compared to free tissue transfer with microvascular anastomosis, the conventional techniques ave advantages with regard to size, technical execution, technical differentiation and rate of healing in. Every skin and soft tissue defect on the upper extremity, however large it is, can be primarily treated by means of a pedicle flap.

We describe a neurovascular island flap of forearm skin based on the radial artery at the wrist level with reversed arterial blood flow. The flap may cover almost any skin and soft tissue defect of the hand. The flap is drained via venous anastomosis between one of the forearm veins and a suitable vein of the hand. Sensation is provided through a microneural anastomosis of one of the sensitive nerves of the forearm to a corresponding nerve of the hand.

The osteo-myoplastic operation of stumps induces the formation of an osseous bridge between the tibia and fibula. The surgical procedure consists of using flexible cortico-periosteal flaps after subcortico-periosteal resection of the osseous stumps. At the same time a myoplastic operation is performed connecting the adductors with the abductors, the flexors with the extensors respectively. The operation technique is described in details. With this treatment a stump is formed that permits exposure to pressure. The stump can be used like a heel. Besides further advantages by this operation the neuro-vascular system becomes normalized. This always causes the preoperative pains to be passed.

According to appearance in high percentage the recent techniques of prosthetic implants are not sufficient in cases of destruction of wrist or arthrosis. Therefore in most cases even intensive physical training cannot give adequate function by full pain relief. With the development of a silicon-caoutchout-prosthesis to replace only cartilage surface without fixation with cement we get a new way, to implant without extensive-resection of bone. The prosthetic material ist very similar to cartilage in hardness and elasticity. Examinations were made on 8 baboons with the result that there was no restriction in function even at full load 6 weeks postoperatonem. Radiological examinations in an observation period of 9 months did not show any significant change as to destruction in the surrounding of prosthetic stem or the articulating surfaces of cartilage and prosthesis.

Plastic surgical procedures in the cranial and cervical area can be performed, in a large number of cases, under local anaesthesia. By using the method of analgo-sedation, sensations of pain and anxiety, which accompain local anaesthesia, can be avoided.

Despite improved techniques in modern x-ray therapy of genital tumors, radioulcera of the groin and lower abdominal wall are still common. The reconstruction of this area can be achieved by a modified abdominoplasty technique. This technique is described and results are demonstrated.

The compression of the r. profundus of n. radialis by m. superior is a rare nerve compression syndrome of the upper extremity. In many cases its diagnosis is very difficult. 14 patients with a emg-manifest supinator syndrome were examined after operation. The examinations were performed as to etiology, symptoms and postoperative status depending on pre-operative duration of trouble.

Hypotension, induced by NNP during simultaneous artificial respiration in intubated patients, has proved its usefulness, especially in plastic surgery of the nose and nasal septum. NNP has shown to be a hypotensive medicament, which is easy to control and in which no secondary effects have been demonstrated. The controlled hypotension with NNP requests an experienced anaesthesist and a careful examination and supervision of the patient.

In 58 patients with extensive deep dermal burns the consequences of intubation, tracheotomy and central venous catheter in respect to pneumonia and bacteriaemia were studied. The sputum of tracheotomized patients showed twice as many pathogenic bacteria as the sputum of patients with prolonged intubation. From 93 subclavian catheters under bacteriological control 16 (17%) showed pathogenic bacteria on the tip. An identity between the bacille found in the blood stream and on the catheter tip was only found in 21%. From this study it seems conclusively that prolonged intubation is generally preverable to tracheostomy in severely burned patients and that the venous catheter can not be the most frequent cause of bacteriaemia.

Since January 1966, 1,390 reduction mammaplasty have been carried out at our clinic. 685 patients on whom we had operated were sent questionnaires containing the following questions: 1. Date of first appearance of the breast hypertrophy 2. Pre-operative complaints arising from too large breasts 3. Patient's post mammaplasty opinion of the breast shape and size. Answers were received from 532 Patients and the following conclusions may be drawn: To 1.: In the majority of cases, hypertrophy of the breasts occurred during puberty and following the first pregnancy. To 2.: Psychological disturbances caused by a too large breast were predominant. However, this was frequently combined with physical complaints. To 3.: Approx. 90% of our patients are satisfied with the post-operative results. Every second patient experiences some change in sensitivity in the region of the mammilli following the operation. Because the patients' post-operative judgment of the aesthetic result is closely correlated with scar tissue formation, we use the less noticeable L-cut in the case of gland resection under 200--300 g and the T-cut only in the case of extensive mammaplasty reduction operations.