Zeitschrift fur plastische Chirurgie最新文献

In a group of eighteen dogs (1977-79) artificially interrupted lymphatics have been bridged by suitable small vein grafts. Patency was controlled by different methods: by clinical microscopical control, by microlymphangiography and by histological examinations. The patency rate in this group was 61.1 per cent. So for the first time it could be shown experimentally that it is possible to restore interrupted lymphatics by grafting. This might be the basis for a causal therapy of secondary lymphedema by reconstruction of interrupted or occluded lymphatics. In a further group of fifteen dogs different autologous grafts have been compared. Each five lymphatic, venous and arterial grafts have been interposed in lymph collectors of 0.3 to 0.6 mm in diameter by the same surgeon applying the same microsurgical and atraumatic technique. The grafts varied from 8 to 25 mm in length. While all the lymphatic grafts remained patent, one of the five venous and all arterial grafts were occluded. There could not be found any correlation of patency rate to length of the grafts. Light microscopical and electron microscopical examinations of the harvested vessels showed heavy pathological findings of the arterial walls. In the venous grafts the intima was thickened to different extent. This could be explained by the lack of blood supply from the lumen. Very likely the occlusion of all arterial grafts seems to be explained by the disturbance of the vessel wall blood supply. The lymphatic grafts histologically showed nearly no pathological damage. There was complete reendothelialization at the suture line of all patent grafts. From these experimental results it is concluded that arteries are not suitable for interposition in order to restore lymph drainage. It could be shown that veins and lymphatics are equally usable for this purpose. Therefore these two structures have been used clinically in cases of therapy resisting lymphedemas for reconstruction of the destroyed lymph paths.

306 patients underwent extensive plastic surgery in the last five years for advanced basal cell carcinoma. In 12 patients either due to delay in presentation or due to inadequate treatment squamous cell carcinoma supervened. In all 12 cases reconstruction was very limited or impossible. Prostheses were used to mask those defects which could not be reconstructed. The infiltrative growth of these squamous cell carcinomas towards the brain could not be controlled. Eventually all the patients developed wide-spread systemic metastases.

For big breasts I no longer use classic Strõmbeck, McKissock or Dufourmentel techniques, because we can be faced with problems of the areolar complex. On the other hand to achieve a good, long lasting result we need to realize a very important reduction. The drawing is done high at 17 +/- 1 cm with the long Wise pattern and the McKissock lazy-S. Only the upper part of the dermis flap is prepared for bed of the areolar complex and for reinforcement of the vertical part of the T scar. This technique of modeling mammectomy is perhaps one of the quickest and safest method of breast reduction. We present our experience after 50 bilateral reductions.

The authors report on the experience in 27 patients with noses damaged by radiation. Different types of local flaps from the forehead and distant flaps from the neck and arm for reconstruction are described.

This is a report on the subjective estimation of breast reduction mammoplasty with regard to the weight of resected tissue. 81 patients followed up have been grouped in 5 sections according to resection weight. In consideration of different aspects (social behaviour, complaints, form-, volume estimation) the subjective judgement on the result has been investigated. Objective and subjective scar quality were faced with each other. Altogether most patients were pleased with the operation result. Best subjective results have been achieved among the groups from 500 to 1500 gm resection weight.

Experiences and results with a so called extended flap transfer including the fascia of the donor leg are discussed. Six patients suffering from complete open fractures of the lower legs underwent this procedure. All patients gained a functional and useful lower extremity. Also late reconstructive operations to cure bony problems did not affect detrimentally the healed flaps.

Considering the female breast to be a secondary sexual organ the sensibility of nipple and areola gains essentially in functional significance. This sensory function is impaired as well by reduction mammaplasty. Thus all different operation methods propagated in recent years have to be rated as to functional and esthetic results with regard to resection weight. The optimal operation method presupposes: 1. Satisfactory esthetic result, 2. optional reductional possibility up to subcutaneous mastectomy, 3. minor sensory impairment of nipple and areola.

Despite more recent operation methods the cross-leg flap technique is still of importance in covering defects at the lower leg and foot. Considering all contra-indications and certain technical particularities while operating with this method good results can be achieved.

Extensive resections of tumors of the scalp penetrating into the bone and the brain often require the use of free flaps for coverage as the only possibility. Four cases are reported and the specific problems of these microsurgical operations in this region are discussed.

A follow-up made 8--17 years after reduction mammoplasty is presented. The series consists of 146 patients, who answered a questionnaire. The patients view on the result is influenced by the following elements: shape, size, scars and sensibility of the nipple compound. Approx. 80 percent of the patients regarded the result as very good or good.