Zeitschrift fur plastische Chirurgie最新文献

Hypertrophic scars and contractures are the result of the contraction of healing burns, giving a rigid mask-like, expressionless appearance of the face. Skin replacement should be done in stages, successively in the various regional entities of the face. The treatment of the burn-scarred skin of the face includes various methods of pedicles flaps, splitt- and full-thickness grafts, hair-bearing grafts to restore eyebrow etc. These alternatives are shown in this paper and illustrated by case reports from our clinic.

In two adults with cavernous hemangiomas occurred symptoms similar to carpal tunnel syndrome. When the angiomas were removed the pains as well hypaesthesia and hypoalgesia in the median nerve area disappeared completely. While in one patient this result stayed on, in the other the same symptoms reappeared when hemangioma recurred. Ischemia in the median nerve area is supposed to be due to shunts in the hemangioma. Their existence could be noticed angiographically as well as histologically in operation specimens.

Primary treatment of cleft lip, jaw and palate is often still performed unsatisfactorily. Severe damage resulting from loss of soft tissue cause considerable functional restriction, so that normal development of the upper jaw is prevented. The choice of suitable corrective mensures is discussed in accordance with the deformity; a new way of forming the philtrum is presented.

Two cases of large Schrudde's slide-swing operations are presented. By the use of these flaps for coverage of major soft tissue defects, excellent coverage is obtained and the protective sensation may be retained or restored by preservation of the cutaneous sensibility.

Lip, jaw and palate clefts are deformities frequently met with. If treated correctly such defects can be reduced to a minimum. Although we naturally seek to achieve aesthetically satisfactory results when shaping the lip, primary osteoplasty plays a decisive role in this process. Primary osteoplasty prevents pseudoprogency which will spoil any success in lip-shaping.

In burn injuries due to their exposed situation the hands are frequently injured and in the moment of the accident they are often used as a shield in front of the face. Mainly the back of the hands are involved. In reconstruction after burns of the back of the hands the scared skin is excised under tourniquet, the displaced interdigital webs are corrected by the method of Tanzer and the skin defect is covered by a thick split-skingraft. From case to case additional operations are: replacement of lost extensor tendons, capsulotomies of the MP-joints, arthrodeses of destroid fingerjoints and amputation of fingers which can't be reconstructed.

Of 187 patients with silicone breast implants 14% developed a capsular formation as late complication needing surgical therapy. Apparently neither the volume and type of prosthesis nor the operative proceeding had any influence on the formation of a constrictive capsule. No significant difference between augmentation plasty by hypo- and aplasia respectively and breast reconstruction after subcutaneous or radical mastectomy could be noticed. There has been no explanation for unilateral hypertrophic capsule formation after simultaneously performed bilateral prosthesis implantation. Compared with other authors we had a smaller incidence of the IIIrd and IVth stage capsular formation. This is caused by: 1. The advantage of a two-stage proceeding over the simultaneous one after subcutaneous mastectomy or subsequently to reconstruction by a flap plasty after radical mastectomy. 2. Systematic drainage of the bed of the prosthesis to avoid any hematoma or big liquid accumulations. Diffusion of silicone in the tissues by spontaneous rupture of the prosthesis as further late complication is discussed in 2 cases.

In the years 1976--1978 we have treated in our hospital 5 patients with progressive hemifacial atrophie (Romberg's disease). To overcome the deformity we used two operations procedures. In three cases the atrophic area was filled out with Plastigel and the asthetic result was good. The advantage of this method can be seen in the simplicity of the operation procedure. Problematical is the mobility of this region of the body and occasionally the absence of subcutaneous tissue to cover the implant. 2 patients with hemifacial atrophy have been treated by a buried de-epithelized neck flap. After 3 operations we obtained a good result.

50 patients with burns received an enzymatic debridement with bacillus subtilis (Protease-ointment = Travase. Symmetrical control sites were treated without Protease-ointment simultaneously. With the help of Protease-ointment early eschar removal was achieved in deep dermal burns. In full thickness burns the success of the treatment was dependent on the depths of the tissue damage and the early application of Protease-ointment, which allowed the removal of the dermal elements of the eschar whereas fat remained unaffected. In our experience Protease-ointment can be considered a valuable method of eschar removal in addition to surgical measures.

We amputated the ringfinger of a 75 years old patient under the diagnosis of a pathologic fracture of the proximal phalanx, based on the case-history and the X-ray-picture. Even knowing the X-ray-findings of the lung only the microscopic evidence confirmed the tuberculosis as the cause of the osteolysis.