Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

{"title":"[Perioperative Assessment and Management of Hypercoagulability and Thrombophilia in Microsurgery: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)].","authors":"Benjamin Thomas, Thorsten Steinfeldt, Ulrich Seyfert, Kai Megerle, Rolf-Dieter Bader, Christine Radtke, Christoph Hirche, Amir K Bigdeli, Ulrich Kneser, Emre Gazyakan, Jurij Kiefer, Björn Behr","doi":"10.1055/a-2535-2467","DOIUrl":"https://doi.org/10.1055/a-2535-2467","url":null,"abstract":"<p><p>Uninterrupted blood flow through microsurgically anastomosed vessels is crucial for the postoperative success of reconstructive microsurgery. Contrary to the highly standardized anastomosis techniques, the pivotal partner discipline of evidence-based microsurgical haemostaseology and haemorrheology is still in its infancy. Prospective clinical studies yielding evidence-based recommendations are notably lacking. Currently, perioperative management in microsurgery is based solely on site-specific empirical experience. The collective aim of these diverse efforts is the preoperative identification of increased coagulation (hypercoagulability) or clotting activities (thrombophilia) and the development of relevant anticoagulation strategies. During the 43rd Annual Meeting of the German-Speaking Working Group for Microsurgery (DAM) in November 2022 in Frankfurt, experts in microsurgery, haemostaseology, and anaesthesia deliberated on the fundamentals of coagulation and physiology. Also, alongside a literature review, consensus recommendations for the perioperative management of hypercoagulopathies were established. Subsequently, methodologies were assessed within the panel, criteria for decision-making were gathered, and, ultimately, a consensus recommendation by DAM regarding a perioperative algorithm was devised, which is detailed in this position paper.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tubular Breast Deformity: Presentation of an Established Treatment Algorithm and Results of a Retrospective Study Over 7 Years].","authors":"Sophia-Theresa Diesch, Vanessa Brébant, Vivien Noisser, Andree Faridi, Lukas Prantl","doi":"10.1055/a-2549-6795","DOIUrl":"https://doi.org/10.1055/a-2549-6795","url":null,"abstract":"<p><p>Congenital deformities of the female breast pose a unique surgical challenge, requiring an individualized approach, particularly for young patients. In this article, we describe a surgical treatment algorithm evaluated over a 7-year period through a retrospective study, focusing on complication rates and breast anthropometric data.A retrospective cohort study was conducted, including 36 patients followed up for 7±3.2 years. All patients underwent surgery based on the proposed therapeutic algorithm. Postoperative assessments were performed at 1 and 6 weeks and 6 months to 10 years. Clinical data, including complications, Baker grade, ptosis degree, and anthropometric measurements, were collected. Additionally, 3D breast images were taken, and a validated patient-reported quality of life outcome measure (Breast-Q™) was administered.Alloplastic augmentation exhibited a significantly higher complication rate (42%) compared with autologous fat transplantation (7.69%). We observed a mean side-to-side difference in areolar diameter of 0.37 cm for autologous reconstruction and 0.78 cm for alloplastic augmentation. The calculated symmetry index revealed 93% symmetry for both therapeutic approaches. All objective measurement methods demonstrated a lasting, symmetrical therapeutic success in correcting congenital deformities. Long-term patient-reported result satisfaction (Breast-Q™) was 74%. Patients undergoing autologous reconstruction required an average of 2.9 procedures to achieve the desired outcome, compared with 1.3 procedures for alloplastic augmentation.The therapeutic algorithm proved to be valid in terms of complication rates, breast symmetry, nipple-areolar complex (NAC) symmetry, and patient satisfaction. It can be considered for patients with congenital breast deformities. Alloplastic reconstruction should be critically discussed due to its increased complication rate.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Phase-Guided Scar Therapy in Wound Healing].","authors":"Ansgar Sanning, Till Sprack","doi":"10.1055/a-2545-0474","DOIUrl":"https://doi.org/10.1055/a-2545-0474","url":null,"abstract":"<p><p>Every skin injury leaves a scar with inferior mechanical properties, which can lead to limitations in function and quality of life. Consistent therapeutic support during wound healing can ensure optimal formation of new tissue. The greatest challenge in scar treatment is the dosage of therapeutic interventions: stimuli must meet the requirements of the tissue in its current state. However, excessive strain on the structure must be avoided to enable proper and undisturbed wound healing. Optimal treatment is based on the patient's fundamental conditions and is adjusted to the specific requirements of the healing tissue throughout the phases of wound healing. Continuous monitoring of the healing process, constant adjustment and selection of techniques, and consistent implementation of manual interventions are essential, particularly in the later stages of scar formation. It is crucial to involve patients in the independent treatment and care of scar tissue to increase the time under adequate tension and maintain the tissue in the best possible condition.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Objectification of Skin Quality in Flap Reconstructions using the Cuto-, Mexa-, and Tewameter: A Comparative Analysis of Sural and ALT Flap Techniques].","authors":"Yonca Steubing, Maxi von Glinski, Marcus Lehnhardt, Christine Seelmann, Heinz Herbert Homann, Arne Beierlorzer","doi":"10.1055/a-2545-0399","DOIUrl":"https://doi.org/10.1055/a-2545-0399","url":null,"abstract":"<p><p>The reconstruction of full-thickness soft tissue injuries on the distal lower extremity depends on the defect size, the patient's risk profile and comorbidities. A pedicled sural flap or a free ALT flap are standard procedures for restoring the tissue. To compare the skin and scar quality of the two reconstructive options, subjective patient perception and satisfaction as well as the objective skin properties were examined using the Patient and Observer Scar Assessment Scale (POSAS), Cuto-, Mexa-, and Tewameter.This retrospective study included 40 patients who received a pedicled sural flap or a free ALT flap for tissue reconstruction on the distal lower extremity between 2013 and 2018. A subjective assessment of skin quality was conducted using the POSAS and a visual analogue scale to determine patients' perception and satisfaction with the surgical results. Skin quality was analysed using a Cuto-, Mexa-, and Tewameter in the flap area, the area surrounding the flap, the healthy contralateral side, the donor site, and the corresponding contralateral side of the donor site.The examination of the subjectively perceived skin and scar quality showed a significantly higher level of satisfaction among patients with ALT flaps than among patients with sural flaps. The POSAS evaluation showed better skin quality at the ALT donor site compared with the sural donor site. The melanin and erythema values recorded by the Mexameter revealed a positive correlation with the POSAS data. In an intra-individual skin comparison, the objective measurements demonstrated that both flaps exhibit reduced elasticity, while both donor sites show increased elasticity compared with the healthy contralateral side. In addition, an increased erythema value was found at the flaps and donor sites compared with the healthy opposite side.The instrument-based measurement methods exhibited objective differences in the skin properties of the examined skin areas. A correlation analysis between subjective perception and objective measurement data demonstrated that visual properties, such as melanin content and erythema, showed a stronger correlation with subjective perception than mechanical properties. Overall, patients with an ALT flap were more satisfied than patients with a sural flap, which can be attributed to a lower morbidity of the donor site.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Deep flexor tendon-rupture close to the insertion combined with simultaneous dislocation of the proximal tendon stump out of the flexor tendon sheath].","authors":"Polina Dimitrova-Chakarova, Karl-Josef Prommersberger, Jörg van Schoonhoven, Marion Mühldorfer-Fodor","doi":"10.1055/a-2525-9314","DOIUrl":"https://doi.org/10.1055/a-2525-9314","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Generation Z in Surgery and 'Work-Life Balance': Challenge or Opportunity?]","authors":"Riccardo E Giunta","doi":"10.1055/a-2524-0253","DOIUrl":"https://doi.org/10.1055/a-2524-0253","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On occasion of the \"ESPRAS - A Day in Paris\" meeting at the 68th SOFCPRE Congress November 21st 2024.","authors":"R E Giunta, J Saboye","doi":"10.1055/a-2534-7628","DOIUrl":"https://doi.org/10.1055/a-2534-7628","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Strategies for Preventing Fires and Thermal Injuries in the Operating Room].","authors":"Maximilian C Stumpfe, Raymund E Horch","doi":"10.1055/a-2513-0574","DOIUrl":"https://doi.org/10.1055/a-2513-0574","url":null,"abstract":"<p><p>Thermal injuries and operating room fires pose significant risks to patients, especially when energy-based devices like monopolar diathermy are used. A study conducted by the FDA over 20 years reported over 3,500 injuries and 178 deaths, mostly caused by burns. The main causes of operating room fires can be explained by the \"fire triangle\": ignition sources, fuels, and oxidizers. Monopolar diathermy and lasers act as ignition sources, while alcohol-based disinfectants provide fuel. As oxidizers, oxygen and nitrous oxide further increase the risk of fire.This review is based on a literature analysis and case vignettes of patients with thermal injuries. It aims to highlight the severe consequences of such injuries and outline preventive measures.The findings underscore the need for a multidisciplinary approach. Key strategies include reducing oxygen concentration and using alternative disinfectants. Targeted training for the surgical team, along with the use of \"Fire Risk Assessment Tools\", can substantially improve patient safety.In conclusion, comprehensive risk management, the development of specific protocols, and team training are essential to prevent thermal injuries and sustainably reduce patient risk in the operating room.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treatment of Congenital Ulnar Impingement Syndrome by Corrective Osteotomy of the Distal Radius - Clinical Results].","authors":"Petr Machac, René Schandl, Roman Wolters, Hermann Krimmer","doi":"10.1055/a-2319-1047","DOIUrl":"10.1055/a-2319-1047","url":null,"abstract":"<p><strong>Background: </strong>In 2016, a new method was described to treat the painful impingement syndrome of the DRUJ: decompression corrective osteotomy of the distal radius. Clinical symptoms are based on a positive compression test; pain occurs with weight-bearing on the forearm. This phenomenon is seen in conjunction with a deformed sigmoid notch together with ulna minus-variance, which leads to increased tension in the distal oblique bundle of the interosseous membrane. The etiology of the condition can be either congenital, post-traumatic, or iatrogenic. Through the proposed osteotomy, decompression in the DRUJ is achieved. This study summarises the results of these surgical procedures performed in our hand centre exclusively in cases of congenital origin.</p><p><strong>Patients und methods: </strong>Remodelling of the DRUJ is achieved through the shortening of the distal radius together with closed wedge osteotomy. Relief of the interosseous membrane is accomplished by ulnar translation of the radial shaft. This study only included patients with congenital incongruency in the DRUJ. The results were evaluated using a visual analogue scale (VAS) and the Krimmer Wrist Score and by measuring the preoperative and postoperative range of motion as well as grip strength.</p><p><strong>Results: </strong>Within 11 years, 45 procedures were performed with our method on 38 patients, of which 17 were treated on the right side, 14 on the left side, and 7 bilaterally. In cases of bilateral incongruency, only the symptomatic side was treated. The statistical evaluation showed a significant reduction of pain on the VAS from 7.2 to 2 (p<0.001). No significant changes were seen in the range of motion (p=0.812). The Krimmer Wrist Score showed good to excellent results in almost 90% of cases.</p><p><strong>Conclusion: </strong>If the indication criteria are met, contraindications are avoided and the osteotomy is correctly performed, this technique leads to an improvement of patients' functionality and quality of life. From a preventive viewpoint, the influence on the progression of the degenerative changes is yet to be demonstrated in further studies. At any rate, this is a safe procedure, which leaves the path open for other possible options.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"17-22"},"PeriodicalIF":0.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Dorsal Screw Osteosynthesis of a Scaphoid Nonunion associated with Congenital Scaphotrapezial and Lunotriquetral Coalitions: A Case Report].","authors":"Jan Wulf, Rainer Schmitt, Adrian Cavalcanti Kußmaul, Wolfgang Böcker, Boris Holzapfel, Fabian Gilbert","doi":"10.1055/a-2348-3256","DOIUrl":"10.1055/a-2348-3256","url":null,"abstract":"<p><p>We present the case of a 24-year-old man who sustained a scaphoid fracture in the presence of congenital scaphotrapezial and lunotriquetral coalitions. As the fracture progressed to a nonunion, a screw osteosynthesis was performed. The altered biomechanics caused by the two coalitions necessitated a dorso-proximal surgical approach, and two screws were implanted to prevent rotational instability. The scaphoid fracture healed entirely.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"71-75"},"PeriodicalIF":0.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}