Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...最新文献

{"title":"[ATTR Amyloidosis for Hand Surgeons: A Hidden, Treatable Systemic Disease].","authors":"Helena Franziska Pernice, Sebastian Spethmann, Katrin Hahn","doi":"10.1055/a-2732-6576","DOIUrl":"10.1055/a-2732-6576","url":null,"abstract":"<p><p>There is strong evidence that carpal tunnel syndrome (CTS) - particularly when bilateral, recurrent or occurring in older adults - is frequently associated with a life-threatening systemic disease, transthyretin (ATTR) amyloidosis. It should, therefore, be recognised as a potential early manifestation of ATTR amyloidosis and prompt further investigations. In this article, we highlight the significance of CTS in the context of amyloidosis and emphasise the key diagnostic steps that should be taken when amyloid is detected in the transverse carpal ligament. These include histopathological subtyping, serum testing for light chains to rule out or enable rapid treatment of AL amyloidosis, and - especially in the presence of cardiomyopathic symptoms - diagnostic evaluation for cardiac amyloidosis as well as genetic testing in cases where ATTR amyloid is identified. In summary, carpal tunnel syndrome is an important early indication of a fatal yet treatable systemic disease that should not be overlooked. Hand surgeons should, therefore, pay particular attention to patients with CTS and, whenever possible, incorporate a histopathological examination of the excised tissue into routine practice.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":" ","pages":"127-134"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of One-Stage Reconstruction of Achilles Tendon and Soft Tissue Defects Resulting from Infection After Achilles Tendon Repair using Flexor Hallucis Longus Tendon Transfer and Reverse Sural Artery Flap.","authors":"Jae Hoon Lee, KiHyeok Ku, Chang Min Kang, Darryl D D'Lima, Jong Hun Baek","doi":"10.1055/a-2681-8656","DOIUrl":"10.1055/a-2681-8656","url":null,"abstract":"<p><p>Infection after Achilles tendon (AT) repair can lead to defects in both the tendon and the surrounding soft tissue. In such cases, a two-stage surgical approach is generally adopted, with soft tissue reconstruction performed initially, followed by secondary tendon reconstruction. A reverse sural artery flap (RSAF) after AT repair is not commonly performed due to potential damage to the flap pedicle. This study aims to evaluate the clinical outcomes of simultaneous flexor hallucis longus tendon (FHLT) transfer and RSAF to treat soft tissue and tendon defects resulting from infection after AT repair.We reviewed 20 patients who had undergone one-stage reconstruction of AT and soft tissue defects resulting from infection after AT repair using FHLT transfer and RSAF between October 2012 and October 2022, with a minimum of a 1-year postsurgical follow-up. Surgical outcomes were assessed based on the success of the flap, recurrence of infection, and tendon re-rupture. Clinical evaluation included visual analog scale (VAS) score, ankle range of motion, and patient-reported components of the American Orthopaedic Foot and Ankle Society (AOFAS) score (maximum of 68 points).All flaps were successful. The mean size of the flap was 7.2×4.1 cm². There was no recurrence of infection or tendon re-rupture. The mean VAS and AOFAS scores were 0.5 and 64.6, respectively. The mean ankle joint range of motion was 13.5° for dorsiflexion and 35° for plantar flexion.One-stage reconstruction with FHLT transfer and RSAF is a safe and effective surgical method in patients with tendon and soft tissue defects after AT repair.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":" ","pages":"180-186"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lymphatic Surgery as Part of the Orthoplastic Concept Post-traumatic Lymphoedema].","authors":"Camillo T Mueller, Felix Reinkemeier, Yonca Steubing, Marcus Lehnhardt, Björn Behr, Johannes Maximilian Wagner","doi":"10.1055/a-2716-6976","DOIUrl":"10.1055/a-2716-6976","url":null,"abstract":"<p><p>The development of secondary lymphoedema is a relevant and frequently observed complication following surgical procedures or trauma. However, one of the main problems is that it is usually not diagnosed or diagnosed very late, resulting in inadequate treatment in many cases. In addition, precise epidemiological data on the incidence of secondary lymphoedema remains scarce. However, delayed or inadequate treatment of secondary lymphoedema usually leads to symptom progression and promotes a chronic course. This underlines the importance of early and accurate diagnosis to guide therapeutic measures and prevent long-term complications. This article provides an overview of the pathophysiology of the lymphatic system, describes the mechanisms underlying the development of post-traumatic lymphoedema, and highlights the role of infections. In addition, it presents the most relevant classification systems, including clinical and imaging-based systems such as Yamamoto's. Current conservative and surgical treatment options are also explained. Interdisciplinary management with modern microsurgical techniques can significantly improve patient prognosis.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":" ","pages":"135-141"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Role and Techniques of Peripheral Nerve Surgery in Orthoplastic Surgery].","authors":"Simeon C Daeschler, Nicolas Ewerbeck, Benjamin Thomas, Roslind Hackenberg, Ulrich Kneser, Arne Hendrik Böcker","doi":"10.1055/a-2790-6989","DOIUrl":"10.1055/a-2790-6989","url":null,"abstract":"<p><p>Orthoplastic surgery integrates principles of trauma surgery and microsurgery to achieve functional restoration in complex limb injuries. While osseous stabilization and soft-tissue coverage have long been established as core components, the importance of early reconstruction of peripheral nerves within the orthoplastic treatment concept is increasingly recognized. The aim of this study is to systematically outline the principles of peripheral nerve surgery in the orthoplastic context.A scoping review was performed with a systematic search of the literature on peripheral nerve surgery in orthoplastic procedures, followed by a narrative synthesis. Original studies, reviews, case series, and clinical guidelines published between 1990 and 2025 were included. The focus was on nerve reconstruction, nerve transfers, neurotized flaps, and strategies for pain prevention in amputations.Peripheral nerve injuries frequently occur as associated injuries in high-energy trauma and have a substantial impact on functional outcomes. Early assessment by peripheral nerve surgeons is essential, as the time window for successful motor reinnervation is limited. In addition to primary repair and autologous nerve grafting, nerve transfers and tendon transfer procedures are increasingly used to achieve functional reconstruction. Neurotized flap procedures, particularly for plantar defect reconstruction, can improve protective sensation and prevent late complications. In major amputations, prophylactic nerve transfers have been shown to reduce the incidence of chronic pain syndromes and to improve prosthetic usability.Peripheral nerve surgery is a key component of orthoplastic care. Its early integration into interdisciplinary treatment algorithms is crucial for long-term functional outcomes. Future studies should aim to standardize indications, techniques, and timing.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":"58 2","pages":"142-150"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnosis of Amyloidosis in Hand and Plastic Surgery Patients: Optimal Tissue Selection and Examination Methods for Early Detection].","authors":"Christoph Röcken","doi":"10.1055/a-2739-3771","DOIUrl":"10.1055/a-2739-3771","url":null,"abstract":"<p><p>Amyloidoses are a heterogeneous group of diseases characterised by the fibrillar deposition of peptides and proteins in a β-sheet configuration. In Germany, AL and ATTR amyloidosis are among the most common systemic forms. ATTR amyloidosis is characterised by the involvement of ligamentous and tenosynovial tissue prior to cardiac involvement, which, in turn, can be be life-limiting. This highlights the growing clinical relevance of diagnosing ATTR amyloid in resection specimens from hand and plastic surgery procedures. Diseases considered relevant in this context include carpal tunnel syndrome, trigger finger, spontaneous biceps tendon rupture, and spinal canal stenosis. The prevalence of ATTR amyloid increases with age, reaching nearly 50% in the ninth decade of life. Tissue samples obtained during surgery should be fixed in formalin. Amyloid can be detected using Congo red staining and polarisation microscopy. The sensitivity of detection depends on both the amount of tissue obtained and the stage of the disease. It should be noted that all tissue and sample types carry a risk of sampling error. Once amyloid has been detected, it must be classified, as amyloidoses are now treatable and treatment depends on the specific type of amyloidosis.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":" ","pages":"111-118"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Early detection of amyloidosis in Handsurgery].","authors":"Riccardo E Giunta","doi":"10.1055/a-2807-5632","DOIUrl":"https://doi.org/10.1055/a-2807-5632","url":null,"abstract":"","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":"58 2","pages":"96-97"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiac Perspective on Amyloidosis: Appropriate Cardiac Diagnostic Approaches Following Histological Amyloid Detection in Tendinopathies].","authors":"Stéphanie Kristina Schwarting, Steffen Massberg, Fabian Aus dem Siepen","doi":"10.1055/a-2716-7046","DOIUrl":"10.1055/a-2716-7046","url":null,"abstract":"<p><p>Amyloidosis is a rare, typically systemic disease that may cause progressive heart failure when cardiac involvement occurs. The two most common subtypes leading to cardiomyopathy - AL and ATTR amyloidosis - differ substantially in terms of diagnosis, treatment, and prognosis. Retrospective studies have shown that musculoskeletal manifestations such as carpal tunnel syndrome, stenosing tenosynovitis, Dupuytren's contracture, or tendon ruptures often occur years before the diagnosis of cardiac amyloidosis and may serve as early clinical markers. A risk-adapted, targeted histopathological work-up, combined with structured interdisciplinary follow-up care, can significantly contribute to the early detection of previously unrecognized systemic amyloidosis. This review highlights the growing importance of musculoskeletal manifestations in the hand surgery setting as potential early indicators of systemic amyloidosis and proposes a structured clinical pathway for interdisciplinary collaboration with cardiology and haematology.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":" ","pages":"119-126"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Patient Protection Has Been Improved by Legislation in Australia?","authors":"Mikko Larsen, Mark Ashton","doi":"10.1055/a-2771-1892","DOIUrl":"10.1055/a-2771-1892","url":null,"abstract":"<p><p>The cosmetic surgery sector in Australia underwent a significant regulatory transformation between 2020 and 2025 following sustained media, professional, and governmental scrutiny. A series of high-profile investigative reports by the ABC Four Corners, Nine Network's 60 Minutes, The Age, and The Sydney Morning Herald revealed systemic deficiencies in clinical oversight, advertising ethics, and patient safety within the cosmetic surgery industry. Public concerns, amplified by evidence of patient harm and misleading practitioner claims, prompted legislative amendments to the Health Practitioner Regulation National Law (Surgeons) Amendment Act 2023 and a comprehensive review of the cosmetic surgery framework by the Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA). This paper analyses the legislative, regulatory, and legal reforms introduced from 2020 to 2025, situating them within the broader context of developments in patient protection, title regulation, and professional accountability. Using document analysis and legal review methods, this paper synthesises statutory changes, Federal Court decisions, and the evolving role of professional colleges in the regulation of medical titles. The findings demonstrate that enhanced patient protection has been achieved through title restriction, stricter advertising regulation, and expanded public access to information about medical practitioners. However, tensions persist regarding the recognition of subspecialisation and professional identity, particularly within the context of multidisciplinary surgical practice.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":"58 2","pages":"174-179"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prevalence of Pisotriquetral Subluxation and Osteoarthritis in Carpal Collapse - Pisotriquetral osteoarthritis with carpal collapse].","authors":"Angelina Garkisch, Mark Immler, Karl-Josef Prommersberger, Dagmar-Christiane Fischer, Sven Märdian, Marion Mühldorfer-Fodor","doi":"10.1055/a-2783-4312","DOIUrl":"https://doi.org/10.1055/a-2783-4312","url":null,"abstract":"<p><p>Carpal collapse (CC), the most common cause of wrist osteoarthritis (OA), results from dissociative carpal instability. The pisotriquetral (PT) joint is usually given little attention, although it can be affected by carpal malalignment, become symptomatic, and may require treatment. The correlation between PT OA and CC has only been investigated in a small case series. The aim of this retrospective data analysis was to investigate the occurrence and severity of PT subluxation and/or PT OA in patients with CC using cross-sectional imaging in a sufficiently large and validated cohort.CT and MRI scans of patients who underwent surgical intervention for pain relief due to CC between 2003 and 2017 were re-evaluated. Parameters for OA and PT joint subluxation were assessed and correlated with the type and severity of CC, classified as scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC), stage II or III.A total of 234 patients (195 men, 39 women) with a mean age of 50±11.6 years were included. Of these, 148 were assigned to the SLAC group (33 patients with stage II; 115 patients with stage III) and 86 to the SNAC group (12 patients with stage II; 74 patients with stage III). PT OA was diagnosed in 76% of all patients; 47% had severe OA. (SLAC stage II: 21%, III: 46%, SNAC stages II and III: 58%). Of 154 patients with PT subluxation, 79% had PT OA, whereas patients without PT subluxation had an OA rate of 69%. Conversely, 69% of patients with PT OA also had PT subluxation, compared with a PT subluxation rate of 55% in patients without PT OA.These results indicate a high co-incidence of PT OA and CC. Obviously, PT OA occurs more frequently and earlier in SNAC than in SLAC, but its prevalence is high in both groups, particularly at stage III CC. This PT pathology concomitant with CC should be considered in all treatment planning, whether conservative or surgical, as it is not readily apparent on standard radiographic imaging.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Proximal Interphalangeal Joint Arthroplasty: Surface Replacement vs. Silicone Spacer].","authors":"Stefan Meuser, Johanna Ueberberg, Martin Richter","doi":"10.1055/a-2774-9467","DOIUrl":"10.1055/a-2774-9467","url":null,"abstract":"<p><p>Since the introduction of the first proximal interphalangeal joint (PIP J) arthroplasty by Brannon and Klein fifty years ago, there has been continuous advancement in implant design and surgical techniques, resulting in an expansion of indications. In addition to primary PIP J osteoarthritis, posttraumatic and inflammatory conditions are increasingly being treated. Besides silicon implants, modern surface replacements have become increasingly popular. This article provides an overview of the history and the current state of PIP J arthroplasty and reviews the outcomes of currently available implants. The various implants are compared regarding their clinical function, revision rates, and economic considerations. Technical aspects, including surgical approach selection and postoperative management, are discussed. Possible complications affecting both range of motion and pain perception are addressed separately, and therapeutic solutions are introduced.</p>","PeriodicalId":520635,"journal":{"name":"Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...","volume":" ","pages":"28-35"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}