Zeitschrift fur plastische Chirurgie最新文献

A suggestion for a modified technique of tenodesis of the distal interphalangeal joint which always leads to a secure tenodesis by using one part of the superficial flexor tendon.

12 cases of finger transposition during replantation using microvascular techniques are reported, all of which were performed in the Department of Plastic and Reconstructive Surgery, Klinikum Rechts der Isar der Technischen Universität München (Head of Department: Prof. Dr. med. Ursula Schmidt-Tintemann). In multiple injuries of the hand, it is sometimes necessary to reconstruct fingers depending on their functional importance, when it is not possible to make a precise anatomical reconstruction owing to the destruction of the various amputated parts. The functional results following finger transposition are comparable to the results following 500 finger replantations in our hospital.

The primary closure of defects of the hand is mandatory. In case of exposure of deeper structures a flap procedure is necessary. Random and axial pattern flaps and also tissue transplantation with microsurgical anastomoses are demonstrated in this paper.

The report covers three cases of mamma augmentation with homoeoplastic fatty tissue, performed elsewhere. The defence reaction takes a three-phase course: 1st Phase: Clinically asymptomatic, with autolysis and capsule formation (1 to 8 years), 2nd Phase: intermittant complaints, hardening of the mammae and enlargement of lymph nodes (after 4 to 91/4 years), 3rd Phase: Acute mastitis (after 5 to 91/4 years). The long-term developments show that mamma augmentation with homoeplastic fatty tissue is a method which is detrimental to health.

It has to be emphasized that the reconstruction of the soft tissue cover of the lower leg is an important procedure. Plastic surgery has to be performed primarily. Otherwise the consequences beside multiple procedures are a very long hospitalization. In this connection, the evaluation of patients shows very grave psychological changes and difficulties in regard to social rehabilitation.

We report on an operating-method for the treatment of the recurrent carpal-tunnel-syndrome by using a synovial-flap-technique. In 4 patients a continuous regeneration of nerve-function could be observed.

Fractures of mp-joints II-V are very important because of the function of these joints for the hand. Accurate anatomical reduction and rigid internal fixation given a good functional result. The defect of cancellous bone by impression is emphasized. In completely destroyed joints primary resection and arthroplasty is performed.

Injuries of the ligaments and capsule of the MCP joints are frequently seen in the hand surgical service. A great part of these injuries are caused by trauma during competitive athletic games. Capsule and ligamental injuries of the 3rd and 4th digit can be treated conservatively by fixation to the next digits. Ruptures of the collateral ligaments of the 1st, 2nd and 5th digit as well as injuries with accompanying fracture or joint instability have to be surgically repaired. The different types of ligamental ruptures and their surgical treatment are discussed.

Methods of surgical reconstruction which are available for wound closure on the lower extremities, following injury of full-thickness defects, are discussed -- especially in relation to indications of primary and secondary procedures. Special mention is given to cross-leg-flaps and tube pedicles of the legs. Indications and technical considerations involved in the treatment of 31 patients with cross-leg-flaps and 38 patients with tube pedicles are reported, as the results obtained from these operations. Out of 50 abdominal tube pedicles (38 patients), 12% were unsuccessful. 30 of the 31 cross-leg-flap were grafted successfully to their predestined sit.

In the typical claw hand deformity following a burn in childhood, the function of the MP-joints can be improved by resection of the metacarpal head and by covering the bone stump by cartilage, pedicled on the periosteum and lifted from the metacarpal head before resection. A "new" metacarpal head will be established, so that the proximal phalanx can glide towards the palm.