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":"[Focus on Hand Surgery Training: Challenges, Perceptions, and Solutions from the Perspective of Trainee Surgeons].","authors":"Julia Glaser, Martin Aman, Karsten Becker, Martin Lautenbach, Jörg van Schoonhoven, Leila Harhaus, Lisa Oezel","doi":"10.1055/a-2622-0845","DOIUrl":"10.1055/a-2622-0845","url":null,"abstract":"<p><p>Training in hand surgery presents a central challenge due to the field's broad requirements, ongoing healthcare reforms, and outpatient care structures. Training is pursued through specialist qualifications such as orthopaedics and trauma surgery, or plastic and aesthetic surgery, and it is supplemented by a two-year additional qualification (Zusatzbezeichnung, ZB) in hand surgery. Despite the significance of hand surgery, comprehensive studies on the subjective perception of training and potential areas for improvement in the German-speaking region are lacking. Given the increasing shift towards outpatient care, which relocates training procedures to the outpatient setting, this study aimed to assess the current training situation and to develop solutions for a more structured surgical education.This study sought to evaluate the quality of practical and theoretical training from the perspective of surgical trainees (Weiterbildungsassistenten, WBA), to identify weaknesses, and to develop targeted measures for optimization. A particular focus was placed on examining these factors with respect to the stage of training, both during specialist training and in the ZB hand surgery program.Between April and June 2024, an online survey was conducted among 117 WBAs in Germany. The survey included questions on demographics, training status, satisfaction, continuing education opportunities, surgical exposure, and subjective perceptions of training. Additionally, data were collected on trainees' wishes, challenges, and issues related to their education.Most participants (63% women, 42% aged 30-34) were enrolled in specialist training (58%) or the additional qualification (ZB) hand surgery program (42%). While satisfaction increased with each year of training, 51% rated their surgical exposure as insufficient. A total of 56% desired more surgical exposure, while 18% sought better individualized mentorship. Frequently reported challenges included staff shortages and inadequate support for continuing education.The findings suggest that targeted measures - such as increased surgical exposure, structured mentoring programs, and better financial support for continuing education - could significantly improve the perceived quality of training. A continuous dialogue between WBAs and trainers is essential to establish practical and motivating trainin.</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":"366-375"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556460","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":"[Selective in vivo force measurement of superficial and deep finger flexor tendons depending on wrist position].","authors":"Simon Bauknecht, Michael Lebelt, Martin Mentzel, Thomas Engleder, Richard-Tobias Moeller, Daniel Vergote","doi":"10.1055/a-2687-6357","DOIUrl":"https://doi.org/10.1055/a-2687-6357","url":null,"abstract":"<p><p>There are different options for further treatment following flexor tendon injuries of the hand. These can be divided into passive and active dynamic treatment regimens. The selection of the optimal further treatment depends primarily on the biomechanically acting forces during postoperative finger exercises. Quantitative biomechanical studies are therefore required. The present experiment examined which forces act on the superficial and deep finger flexor tendons in different wrist positions. A measuring device was developed with the help of which both the total forces of the fingers and the isolated forces of the superficial (FDS) and deep (FDP) finger flexor tendons could be quantified in vivo. The measurements were evaluated on the index, middle, ring and little fingers (D2 - D5) of both hands of 50 test subjects, including 31 women (62%) and 19 men (38%). The influencing factors handedness, gender, fingers and wrist position were checked for interdependence using mixed ANOVA (p<0.05) and further differentiated using t-tests and one-factor ANOVAs (p<0.05). There was a statistically significant reduction in finger strength by flexing the wrist. On average, the highest forces were recorded at D3 and the lowest at D5. There was no significant difference between D2 and D4. On average, higher forces were achieved at D2, D3 and D4 by the FDS than by the FDP. At D5 there was a reversed force relationship with a higher force development of the FDP. The sum of the isolated forces of the FDS and FDP at D2 to D4 was around 80%, at D5 it was only 60%. The remaining force development can be explained by the influence of the metacarpal muscles and, in the case of D5, also by the flexor digiti minimi muscle. The results enable a differentiated assessment of the biomechanical forces acting during active finger flexion.</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":"57 5","pages":"319-326"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350857","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":"[Current Advances in the Diagnosis and Surgical Treatment of Neuromas].","authors":"Julia Glaser, Martin Aman, Leila Harhaus","doi":"10.1055/a-2661-9851","DOIUrl":"10.1055/a-2661-9851","url":null,"abstract":"<p><p>Symptomatic neuromas of the upper and lower extremities present significant challenges for affected individuals in both daily life and professional environments following peripheral nerve injuries. Traditional approaches, such as neuroma excision or conservative therapy methods, have so far predominated. In recent years, however, peripheral nerve surgery has expanded the therapeutic spectrum for neuroma treatment through approaches such as nerve reconstruction with allo-/autografts, end-to-side neurorrhaphy, targeted muscle reinnervation (TMR) surgery, and regenerative peripheral nerve interface (RPNI) procedures (1).</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":"356-365"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083241","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":"[Therapy of Scaphoid Nonunion: Treatment Algorithm and Union Rate Analysis after Autologous Reconstruction].","authors":"Ayla Antonia Hohenstein, Cam Tu Nguyen, Johannes Zeller, Mark Fricke, Horst Zajonc, Steffen Ulrich Eisenhardt, Nico Leibig","doi":"10.1055/a-2685-3879","DOIUrl":"https://doi.org/10.1055/a-2685-3879","url":null,"abstract":"<p><p>Scaphoid nonunion develops in approximately 15% of patients following scaphoid fractures. To prevent carpal collapse, targeted diagnosis and early initiation of treatment are crucial.This paper describes the algorithm for scaphoid nonunion treatment established at the Department of Plastic and Hand Surgery at the Medical Center - University of Freiburg. We carried out a monocentric, retrospective analysis of scaphoid reconstructions for scaphoid nonunion performed at our clinic between January 2012 and December 2022. We selected among four treatment options based on the vascularity of the proximal pole and the size of the substance defect, and / or the presence of a humpback deformity. In cases of a vital proximal scaphoid pole, reconstruction was performed using avascular autologous bone grafts: radius cancellous bone if there was no substance defect, or iliac crest bone if there was a relevant substance defect or a humpback deformity. In cases of an avital proximal pole without a relevant substance defect or humpback deformity, reconstruction was performed using a pedicled bone graft from the radius. In the presence of a substance defect or humpback deformity, a medial femoral condyle free flap was used. We analysed the union rate and epidemiological data of the patient cohort.A total of 123 scaphoid reconstructions were included. The median follow-up was 422 days. According to the established algorithm, 13 reconstructions were performed with cancellous bone grafts from the radius, 82 with iliac crest bone grafts, 13 with pedicled bone grafting from the radius, and 15 with medial femoral condyle free flaps. Union rates were 84.6% for reconstructions using cancellous bone grafts from the radius, 79.3% for iliac crest bone grafts, 69.2% for pedicled bone grafts from the radius, and 86.7% for medial femoral condyle free flaps. We identified nicotine abuse as an independent risk factor for scaphoid nonunion in patients undergoing reconstruction with iliac crest bone grafts.In line with current literature, we confirmed the importance of nicotine abstinence in scaphoid reconstructions. Since the treatment algorithm in our analysis was predetermined due to the retrospective design, no conclusions can be drawn regarding the superiority of any method. Prospective, randomised trials are needed to demonstrate the superiority of a treatment method.</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":"57 5","pages":"335-343"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350966","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":"[From suture to function: Evaluating an early functional rehabilitation approach for flexor tendon repairs in the context of current concepts].","authors":"Tim Friebe, Jörg van Schoonhoven","doi":"10.1055/a-2688-9134","DOIUrl":"10.1055/a-2688-9134","url":null,"abstract":"<p><p>Evaluating an early functional rehabilitation approach for flexor tendon repairs in the context of current concepts ABSTRACT Background: In recent years, an increase in scientific research on the post-treatment of flexor tendon repairs has been observed. To evaluate the effectiveness and safety of the \"Early-Active-Motion\" concept that has been used in our clinic for over 10 years, a prospective study was developed that detailed both functional outcomes and complication rates over a period of 3 months.90 flexor tendon repairs in Zones 1-3, with and without accompanying injuries, were examined after three, six, nine and 12 weeks. Compliance was not a reason for exclusion. The collected parameters included the DASH, finger mobility according to the Strickland-Score, and other assessments.Out of a total of 90 flexor tendons, follow-up was achieved on 67 over a period of three months. Overall, 43 of the tendons achieved an excellent or good outcome. 20 had a fair outcome, and 4 of the digits had a poor Strickland Score. A total of three ruptures were documented.The \"Early-Active-Motion\" concept achieves a functionally good outcome with a Strickland-Score of 76 points. It is applicable from Zone 1 to Zone 3, even in complex flexor tendon injuries. Early phase deterioration appears to be an indicator of lower final outcomes.</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":"327-334"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246165","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":"[Final sprint for the hybrid DRG radius fracture].","authors":"Marion Mühldorfer-Fodor","doi":"10.1055/a-2675-5764","DOIUrl":"https://doi.org/10.1055/a-2675-5764","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":"57 5","pages":"317-318"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350868","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":"[Intraoperative Shock-Wave Application in Scaphoid Reconstruction with Non-Vascularised Bone Grafts: A Randomised Controlled Trial].","authors":"Marion Mühldorfer-Fodor, Matthias Wagner, Tanja Kottmann, Jörg van Schoonhoven, Karl-Josef Prommersberger, Jakob Richard Schnegg","doi":"10.1055/a-2701-8768","DOIUrl":"10.1055/a-2701-8768","url":null,"abstract":"<p><p>Focused high-energy extracorporeal shock-wave therapy (ESWT) promotes bone healing through neo-angiogenesis, pooling of stem cells, and activation of osteocytes. This study investigated whether additional intraoperative ESWT improves or accelerates the healing rate of scaphoid reconstruction with non-vascularised bone grafts in cases of pseudarthrosis.This randomised, controlled study included 93 patients who underwent scaphoid reconstruction with a non-vascularised bone graft (radius cancellous bone, iliac crest cancellous bone, or iliac crest corticocancellous graft). The patients were divided into two groups: an intervention group that received intraoperative ESWT in addition to the reconstruction, and a control group that received sole reconstruction. Healing rates as well as the percentage of osseous bridging between the scaphoid and the bone graft were evaluated and compared clinically and radiologically at 12, 18, and 24 weeks postoperatively.After 24 weeks, 80% of the scaphoids (37 of 46) in the intervention group had healed, compared with 66% (31 of 47) in the control group. Healing rates in the proximal third of the scaphoid were 77% in the intervention group and 76% in the control group. In the middle third, healing rates were 82% and 57%, respectively. All pseudarthroses of the distal third healed. After 12 weeks, the percentage of osseous bridging of the scaphoid distal to the graft was significantly higher in the intervention group (87% versus 80%), but not proximal to the graft.A single intraoperative ESWT improves the healing rate of scaphoid reconstruction with a non-vascularised bone graft and accelerates bone healing during the first 12 postoperative weeks.</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":"57 5","pages":"344-355"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350933","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":"[Who Pays? Postoperative Complications and Treatment Costs Following Aesthetic Surgery in Germany and Abroad].","authors":"Simon Andreas Mayer, Victoria Franziska Struckmann, Yannick Fabian Diehm, Florian Falkner, Benjamin Thomas, Ulrich Kneser, Laura Cosima Siegwart","doi":"10.1055/a-2616-0691","DOIUrl":"10.1055/a-2616-0691","url":null,"abstract":"<p><p>In Germany, more than 460,000 aesthetic surgical procedures are performed each year. Driven by lower costs, aesthetic surgeries abroad are also gaining popularity. However, there is a lack of official data on acute complications, their management, and the resulting healthcare costs.We conducted a retrospective study including all patients who required inpatient treatment for acute postoperative complications following aesthetic surgery in Germany or abroad (January 2018 to March 2024). We analysed patient characteristics, the type of aesthetic procedure, the country in which the aesthetic surgery was performed, complications, revision procedures, treatment costs, and the presence of follow-up cost insurance.Fifty patients were included in the study. The aesthetic procedures were primarily performed in Germany (44%), Turkey (32%), and the Czech Republic (16%). The most common complications were infections (54%) and wound dehiscence (34%). Re-operation was performed in 94% of patients and 8% of patients required intensive care treatment due to life-threatening complications. The average cost of inpatient treatment was EUR 6,192. Only 28% of patients had a follow-up cost insurance.Aesthetic surgery can lead to serious postoperative complications that frequently necessitate re-operation and result in high treatment costs. Comprehensive patient education, including the recommendation of follow-up cost insurance and medical care, should be provided to enhance patient safety and reduce the cost burden on both patients and the healthcare system.</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":"276-282"},"PeriodicalIF":0.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683955","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":"[Open Access: In Between the Bright and the Dark Side].","authors":"Paolo Alberton, Paul Severin Wiggenhauser, Nicholas Möllhoff, Konstantin Christoph Koban, Riccardo E Giunta","doi":"10.1055/a-2654-7594","DOIUrl":"10.1055/a-2654-7594","url":null,"abstract":"<p><p>The open access movement began in the 1990s, but it is only in recent years that the phenomenon has really taken hold and has become a tangible commitment for the scientific community. While open access is fundamentally intended to enhance knowledge accessibility and promote data transparency, its rapid expansion has exposed significant systemic vulnerabilities. Most notably, the emergence of so-called \"predatory journals\" - criticized for prioritizing publication volumes over rigorous peer review - poses a serious threat to the integrity of scientific research. As a result, many institutions have come to view them with scepticism or disregard them entirely. In this review, we aim to provide an impartial perspective on open access in scientific publishing, with particular attention to the potential drawbacks and pitfalls for the scientific community. While the benefits of open access are evident and widely acknowledged, this review specifically examines areas where it has drawn criticism. Finally, after highlighting these challenges, we explored how institutions currently support researchers - and how they could further strengthen this support - in meeting their obligations.</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":"291-299"},"PeriodicalIF":0.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791772","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":"[From Liposuction to Reconstruction: Interdisciplinary Management of Necrotising Fasciitis after Outpatient Liposuction in a Non-Specialist Setting].","authors":"Moritz Billner, David Breidung, Konrad Karcz, Dominik Promny, Denis Ehrl","doi":"10.1055/a-2639-8914","DOIUrl":"10.1055/a-2639-8914","url":null,"abstract":"<p><p>This case report describes the clinical course of necrotising fasciitis as a serious complication following outpatient liposuction. The patient required extensive surgical procedures, including radical debridement, negative pressure wound therapy (NPWT) and multiple flaps to cover the extensive tissue defects, alongside prolonged intensive medical care. This case underscores the risks associated with aesthetic procedures and emphasises the importance of having such procedures performed exclusively by qualified and experienced specialists. This case also impressively demonstrates the importance of early diagnosis and interdisciplinary management.</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":"57 4","pages":"307-311"},"PeriodicalIF":0.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839867","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}