Zeitschrift fur plastische Chirurgie最新文献

Successful replantation of total amputated parts of the hand having been performed during a period of five years were investigated as a homogenous group. Long-term function of replanted parts was evaluated by objective criteria, as signs of use, trophique, vascularisation, mobility, sensibility and the integration of replants into general function of the hand, and on the other side by subjective criteria as usefulness in professional and private life, retrospective personal attitude to replantation and subjective complaints.

The late results of replantation of thumbs have shown that with the microsurgery we could receive better results than with secondary reconstruction of a thumb.

Two different or general types of arthroplasty for treatment of the saddle-joint-arthrosis are usual: particular bone-resection (base of first metacarpal or part of the trapezium) or complete resection of the trapezium, both combined with an interposition. The last one is essentially used in carpometacarpal arthroplasty. Two main groups are known: tendon-interposition and silastic prostheses. Most authors describe the dislocation of the first metacarpal, followed by pain and instability, in 20% of all cases. Neglecting of the ligament conditions seems to be the mainfault. In nearly all cases the ligaments can be found destroyed or elongated. Functional reconstruction is difficult or impossible, therefore a tendon-plasty should be done to restore the function of the ligaments. Some other mistakes and complications are reported. Planning a saddle-joint-arthroplasty they should be known as the best protection against bad results.

During the last two years, 16 severe explosion injuries of the hand have been treated with plastic microsurgery in our hospital. The injury had arisen in seven cases from the mixture sugar + sodium chlorate (C12H22O11 + NaClO3). This substance mixture may already be caused to explode by slight vibrations and the warmth of the hands. In explosion injuries, there is mechanical, chemical and thermal tissue damage. The postoperative course is therefore complicated in almost all cases. However, by meticulous removal of the disseminated foreign particles, excision of necrotic tissue and extensive reconstruction of the interrupted vascular and nerve supply, it is possible in a few cases to preserve functionally important parts of the hand. Later plastic procedures are made more difficult by tissue fibrosis and foreign body granulomas.

On regard to the butterfly flap plasty of SHAW 1973, we developed a modified technique by enlarging this method. This method will deepen the interdigital fold without transplantation of skin. We have operated between 1976--1979 twenty two patients by this method with a rather good functional and aesthetic result.

In spite of prophylactic treatment pressure sores in para- and tetraplegics often occur. The pressure ulcers are mostly found in certain places. Surgical intervention will be eventually necessary in most cases. Surgery should include the radical excision of the ulcer, the removal of prominent bone areas and the closure of the defect. In order to avoid large scars the surgical procedure should not exceed a certain extent. We feel that the slide and swing method after Schrudde is the most efficacious because by means of this technique large scars and free transplants which are very sensitive postoperatively can be avoided. We report on a total of 128 patients with 169 pressure sores.

From 1972 to 1977 we operated on 40 patients with complete or incomplete facial palsy. There were only such cases in which a spontaneous or operative reinnervation could not be expected. Anamneses between appearance of the facial palsy and its operation was 11,8 years on an average. Different substitute operations for aesthetic and functional improvement were applied. Only a combination of different operation methods leaded to a satisfying result.

After the diagnosis of transsexuality is well definated and recognized in most western countries, the surgical transformation of the genital area is performed. Before surgical treatment an exact psychiatric clarification is absolutely essential. The operation is the last part of a long treatment. The surgical result in the more common female transsexual is quite reasonable. The treatment of the fewer male transsexuals is not solved completely, especially the reliable techniques for penis reconstructions are not very sufficient.

Our report is based on the treatment of 100 extensive burns with the employment of fresh frozen porcine skin used as biological dressings. Our experience shows that fresh frozen porcine skin equals in most respects non-typed homografts. Its utilization is economical and it is also recommended in cases where the number of human donors is limited.

In the treatment of burn injuries the CO2-Laser has meanwhile proved to be an effective cutting-instrument as well as the Bowie-Knife. A trial-study was carried out in which the necroses were excised simultaneously with the Laser on one side of the body and with the Bowie-Knife on the other. Comparisons were made between blood-loss, time used for escharotomie, injury to the wound bed and post-operative healing of the autograft 4 and 8 days later. The results of the parameter showed that with the Laser there was a reduction in blood-loss of 50% compared with the Bowie-Knife. On the other hand the total operating-time was 1/3 longer, including the time necessary for hemostasis to take place. The blood-loss was measured with a Blood-Loss-Perometer and the result was converted according to the extent of the burned surface area. Histology showed less trauma of the wound bed compared with the Bowie-Knife, rare hemorrhages and inflammatory reactions in Laser so that healing of the autograft proceeded without complications.