Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

{"title":"DGH-Newsletter 2023.","authors":"","doi":"10.1055/a-2158-0393","DOIUrl":"https://doi.org/10.1055/a-2158-0393","url":null,"abstract":"Liebe Mitglieder der DGH, gerne informiere ich Sie auch in diesem Jahr über die Aktivitäten des Vorstands der Deutschen Gesellschaft für Handchirurgie und lasse Ihnen mit diesem Newsletter alle wesentlichen Informationen für die Mitgliederversammlung im Rahmen unseres Jahreskongresses am 12. Oktober 2023 in Leipzig zukommen, zu der ich Sie bereits an dieser Stelle ganz herzlich einlade.","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41121370","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":"Outcomes of Surgery for Benign Tumours in The Upper Extremity.","authors":"Andrzej Zyluk,&nbsp;Ada Owczarska","doi":"10.1055/a-2008-0772","DOIUrl":"10.1055/a-2008-0772","url":null,"abstract":"<p><p>Benign tumours of the upper extremity are common in hand surgeons' practice. The most commonly diagnosed are giant-cell tumours of the tendon sheath and lipomas.</p><p><strong>The objective: </strong>of this study was an investigation into the distribution of tumours in the upper limb, their symptomatology and outcomes of surgery, particularly regarding the rate of recurrence.</p><p><strong>Material and methods: </strong>A total of 346 patients, 234 women (68%) and 112 men (32%), who had undergone surgery for tumours located in the upper extremity which were not ganglion cysts were enrolled into the study. The follow-up assessment was performed at a mean of 21 months (range 12-36) post-operatively.</p><p><strong>Results: </strong>The most common tumour in this study was giant cell tumour of the tendon sheath - 96 cases (27.7%), followed by lipoma - 44 cases (12.7%). Most lesions - 231 (67%) were localized in the digits. A total of 79 (23%) recurrences were noted, the most common after surgery for rheumatoid nodules - 43.3% and the giant-cell tumours of the tendon sheath - 31.3%. The independent factors increasing risk of recurrence following the tumour's resection were: histological type of the lesion - the giant-cell tumour of the tendon sheath (p=0.0086) and the rheumatoid nodule (p=0.0027), as well as a combination of incomplete (non-radical) and not \"en block\" resection of tumours. A brief review of the literature referring to the presented material is offered.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9090492","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":"[Current Trends in Flexor Tendon Surgery: Results of a National Online Survey].","authors":"Elisabeth Maria Haas-Lützenberger,&nbsp;Johannes Strolla,&nbsp;Riccardo Giunta,&nbsp;Elias Volkmer","doi":"10.1055/a-2060-0755","DOIUrl":"10.1055/a-2060-0755","url":null,"abstract":"<p><p>Within the last 50 years, there has been a change in trend in flexor tendon surgery. After the introduction of the 2-strand technique, the 4-strand technique was propagated in the 1990s. In order to obtain a status quo of which technique is used in Germany and if the gold standard of the 4-strand suture has changed in favour of a 6-strand suture, we conducted an online survey among members of the DGH (\"Deutsche Gesellschaft für Handchirurgie\", German Society for Hand Surgery) on the suture technique of flexor tendon injuries zone 2.</p><p><strong>Material and methods: </strong>An online survey was conducted and sent out by email to all DGH members. The questionnaire included 7 questions. Participants accessed the survey via a link.</p><p><strong>Results: </strong>155 hand surgeons from Germany participated in the survey. All of them answered the questionnaire in full and all questionnaires were included in the evaluation. The main question of how many strands are currently used for core suturing was answered as follows: 21% (n=32) of the 155 participants (TN) stated that they use a 2-strand suture, 53% used (n=82) a 4-strand suture and 10% used a 6-strand suture. Regarding techniques, 81 TN used the Kirchmayr-Kessler technique or a modification of it, 9 TN used the M-Tang technique, and 15 TN indicated \"other technique\". The question about the application of an epitendinous suture was overwhelmingly answered with \"yes\". Here, 98.2% agreed. Only with regard to the suture material, different opinions were found. 68% (n=106) use an absorbable monofilament suture (such as PDS). Just under a quarter (23%, n=36) use a non-absorbable monofilament suture (such as Prolene).</p><p><strong>Conclusion: </strong>Flexor tendon surgery has changed considerably due to intensive advances in research during the last decades. It was interesting to note in our survey that German hand surgeons have adapted their suture technique within the last years based on the results of the literature. Our results clearly show that convincing scientific data has an influence on the choice of surgical technique and that discussions about new techniques, e. g. in the context of annual meetings, may well stimulate the auditorium to rethink.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10241523","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":"Kongress-Saison.","authors":"Marion Mühldorfer-Fodor","doi":"10.1055/a-2023-3580","DOIUrl":"https://doi.org/10.1055/a-2023-3580","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141486","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":"[Cosmetic outcome of nasal tip reconstruction with the frontonasal flap and other locoregional flaps - Cosmetic Outcome of Nasal Tip Reconstruction].","authors":"Julian Ramin Andresen,&nbsp;Oliver Scheufler","doi":"10.1055/a-2069-2246","DOIUrl":"https://doi.org/10.1055/a-2069-2246","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the results of nasal tip reconstruction with the frontonasal flap compared with other locoregional flaps.</p><p><strong>Material and methods: </strong>All nasal tip reconstructions with locoregional flaps performed during a 10-year period were included. Defect size, flap type, risk factors, comorbidities, complications, revisions, and secondary operations were retrospectively assessed. Clinical follow-up examinations were performed after 12 months. Digital photographs were taken in standard projections preoperatively and at the time of the last follow-up examination, and the aesthetic results were assessed by three independent examiners, with nasal contour, symmetry, scarring, and match of skin colour between flap and nasal skin rated on a 4-point scale. Finally, patient satisfaction was obtained.</p><p><strong>Results: </strong>A total of 112 nasal tip reconstructions were performed in 68 women and 44 men with a mean age of 71,4±10,2 years. Taking into account defect size, individual factors and patient preference, reconstruction was performed with 58 frontonasal flaps, 23 Rintala flaps, 20 paramedian forehead flaps and 11 bilobed flaps. Mean age and comorbidities of patients were comparable between flap types, except for a higher incidence of arterial hypertension and a lower incidence of diabetes mellitus in patients treated with frontonasal flaps. Defect size was the same in reconstructions with frontonasal flaps and Rintala flaps, smaller in bilobed flaps, and more extensive in paramedian forehead flaps. There were no differences in complication rates between the different flap techniques. Taking into account the planned second interventions (flap pedicle separations) in the paramedian forehead flaps, the frequency of unplanned corrections was comparable for all flap techniques. Aesthetic results and patient satisfaction were rated as very good or good in more than 90% with all techniques.</p><p><strong>Conclusions: </strong>Compared with the paramedian forehead flap, the frontonasal flap avoids a planned secondary procedure and an extensive donor defect. It allows for the coverage of defects at least the size of the Rintala flap and larger defects than the bilobed flap.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/92/10-1055-a-2069-2246.PMC10415061.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10336987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Settlement of the surgical treatment of lipoedema].","authors":"Melodi Motamedi,&nbsp;Matthias H L Gensior,&nbsp;Mojtaba Ghods,&nbsp;Anja M Boos,&nbsp;Philipp Kruppa,&nbsp;Sixtus Allert","doi":"10.1055/a-2057-6192","DOIUrl":"https://doi.org/10.1055/a-2057-6192","url":null,"abstract":"<p><p>The billing of lipoedema treatment in Germany has come to be heterogeneous. This is due to the decision of the Federal Joint Committee (\"Gemeinsamer Bundesausschuss\", G-BA) to acknowledge lipoedema stage III as a treatment to be paid by the statutory health insurance funds (\"Gesetzliche Krankenversicherung\", GKV) until the completion of the trial study \"LipLeg\" at the end of 2024. Based on this decision, inpatient and outpatient surgical treatment of stage III lipoedema can be billed to the GKV, while the reimbursement of costs for surgical treatment of the other two stages remains a case-by-case decision of the GKV and is currently often rejected. Therefore, treatment costs are often paid by patients themselves. The question of the correct settlement of lipoedema treatment repeatedly arises in the context of legal disputes, which, in turn, repeatedly faces experts and courts with a major challenge. In the following article, the Task Force Lipoedema of the German Society for Plastic, Reconstructive and Aesthetic Surgery presents an overview of the various billing modalities and presents a proposal for the correct billing of lipoedema within the framework of the German medical fee schedule (\"Gebührenordnung für Ärzte\", GOÄ).</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9976632","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":"[Necklift: the optimal local technique for each neck].","authors":"André Borsche,&nbsp;Gottfried Lemperle","doi":"10.1055/a-2032-3876","DOIUrl":"https://doi.org/10.1055/a-2032-3876","url":null,"abstract":"Zusammenfassung Eine Vielzahl Patienten stört nur der Hals, sei es ein leichtes Doppelkinn, ein Fetthals, die auffälligen medialen Platysma-Stränge oder ein richtiger „turkey gobbler“. Für jede dieser Indikationen gibt es eine geeignete Operationsmethode, die Alter und Vorstellung der Patienten, aber auch die Beschaffenheit der Haut, deren Fettgehalt, und die Ausprägung der Falten im ganzen Gesicht und am Hals in Betracht zieht. Hier werden 8 verschiedene moderne Techniken vorgestellt, die einzeln, aber auch in Kombination durchgeführt, für jeden Patienten individuell ausgewählt werden können. 1. Ein „angedeutetes Doppelkinn“ wird abgesaugt 2. Ein „ausgeprägtes Doppelkinn“ wird horizontal exzidiert 3. Ein „reiner Fetthals“ wird abgesaugt und die Haut exzidiert 4. „Lockere Halshaut“ wird vertikal exzidiert oder als Facelift gestrafft 5. Ein ausgeprägter “Truthahnhals“ wird vertikal exzidiert oder als vertikales Facelift gestrafft Abstract A large number of patients are only bothered by their neck, be it due to a mild double chin, a fatty neck, noticeable medial platysma lines or a real “turkey gobbler”. For each of these indications, there is an optimal surgical method that takes into account the patient’s age and presentation, but also the texture of the skin, its fat content, and the expression of wrinkles throughout the face and neck. Here we present eight different modern techniques, which can be performed as single measures or in combination and may be selected individually for each patient. 1. a “suggested double chin” is suctioned 2. a “pronounced double chin” is excised horizontally 3. a “pure fat neck” is suctioned and the skin excised 4. a “loose neck skin” is excised vertically or tightened as a facelift 5. a pronounced “turkey gobbler” is excised vertically or tightened as a vertical facelift","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10146155","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":"[Update and Trends in Breast Reconstruction After Mastectomy].","authors":"Paul Supper,&nbsp;Lorenz Semmler,&nbsp;Eva Placheta-Györi,&nbsp;Maryana Teufelsbauer,&nbsp;Elissa Harik-Chraim,&nbsp;Christine Radtke","doi":"10.1055/a-2082-1542","DOIUrl":"https://doi.org/10.1055/a-2082-1542","url":null,"abstract":"<p><p>Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. It has become more difficult to advise patients due to the expansion of oncologic options for mastectomy, radiation therapy and the variety of reconstructive techniques. The goal of reconstruction is to achieve oncologically clear margins and a long-term aesthetically satisfactory result with a high quality of life. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. However, secondary reconstructions often have a higher satisfaction, since here no restitutio ad integrum is assumed. Alloplastic, i. e., implant-based, breast reconstruction and autologous breast reconstruction are complementary techniques. This article provides an overview of current options for breast reconstruction including patients' satisfaction and quality of life following breast reconstruction. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delayed reconstruction does not appear to compromise clinical or patient-reported outcomes. Recent refinements in surgical techniques and autologous breast reconstruction include stacked-flaps, as well as microsurgical nerve coaptation to restore sensitivity, which lead to improved outcomes and quality of life. Nowadays Skin-sparing and nipple-sparing mastectomy, accompanied by improved implant quality, allows immediate prosthetic breast reconstruction as well as reemergence of the prepectoral implantation. The choice of breast reconstruction depends on the type of mastectomy, necessary radiation, individual risk factors, as well as the patient's habitus and wishes. Overall, recent developments in breast reconstruction led to an increase in patient satisfaction, quality of life and aesthetic outcome with oncological safety.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9b/d2/10-1055-a-2082-1542.PMC10415025.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10338619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Stacked PAP flap for unilateral breast reconstruction: a case report].","authors":"Shaghayegh Gorji,&nbsp;Charalampos Varnava,&nbsp;Matthias Aitzetmüller,&nbsp;Marie-Luise Klietz,&nbsp;Tobias Hirsch,&nbsp;Philipp Wiebringhaus","doi":"10.1055/a-2084-0893","DOIUrl":"https://doi.org/10.1055/a-2084-0893","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the PAP (profunda artery perforator) flap has gained popularity in reconstructive breast surgery. However, the tissue available for flap harvest is usually limited. Therefore, grafting two PAP flaps to form a stacked PAP flap for unilateral reconstruction of large breasts is a safe and reliable option. Patient We present the case of a 59-year-old patient arriving at our unit with prior bilateral nipple-sparing mastectomy and implant-based reconstruction after diagnosis of BRCA-2 mutation and breast cancer. Autologous reconstruction with a DIEP flap was the initial treatment suggested to our patient. Preoperative CT scans showed subpar perforators not suitable for anastomosis, ultimately resulting in unilateral DIEP flap reconstruction on the left side. After an uneventful postoperative period, the patient requested autologous conversion of the right side due to persistent symptomatic capsular contracture. To achieve symmetry with the contralateral breast, we decided to perform a stacked PAP flap for unilateral breast reconstruction.</p><p><strong>Results: </strong>The combined flaps provided enough tissue to achieve a satisfactory aesthetic result and symmetry and weighed 600 g in total, while the single DIEP flap on the left side weighed 716 g. There were no complications during the surgical procedure. Postoperative recovery was uneventful, and the patient was discharged after seven days. There were no signs of adipose tissue necrosis at the most recent check-up. On the left donor side, there was a small wound healing defect, which healed well non-surgically. The patient was satisfied with the results.</p><p><strong>Conclusion: </strong>The PAP flap has become an established alternative to standard breast reconstruction procedures. The stacked PAP flap can provide a safe and efficient method for unilateral reconstruction of large breasts. Perfusion and drainage through the inferiorly anastomosed flap showed sufficient outflow and did not lead to increased adipose tissue necrosis. In our case, the total surgery time was not substantially longer than in single PAP flap surgery. Furthermore, the possibility of unilateral placement of two flaps may avoid follow-up operations such as multiple lipotransfers to equalise both breasts.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9975579","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":"[Breast implant-associated squamous cell carcinoma: a systematic literature review].","authors":"Nicholas Möllhoff,&nbsp;Denis Ehrl,&nbsp;Benedikt Fuchs,&nbsp;Konstantin Frank,&nbsp;Verena Alt,&nbsp;Doris Mayr,&nbsp;David Braig,&nbsp;Riccardo E Giunta,&nbsp;Christine Hagen","doi":"10.1055/a-2108-9111","DOIUrl":"https://doi.org/10.1055/a-2108-9111","url":null,"abstract":"<p><strong>Background: </strong>Breast implant-associated squamous cell carcinoma (BIA-SCC) is being discussed as a distinct malignant tumour entity originating from the implant capsule. The FDA and the ASPS published a safety communication on BIA-SCC in 2022, with a first case report of BIA-SCC having been published in the 1990s. This manuscript summarises the current scientific data on this rare tumour entity.</p><p><strong>Material and methods: </strong>This systematic literature review from two independent databases includes all publications of cases with histopathologically confirmed BIA-SCC. Data extraction included study design, demographic data, implant information and details regarding diagnosis and treatment.</p><p><strong>Results: </strong>Nineteen cases of BIA-SCC with a mean age of 57±10 years were reported in 16 publications. In most cases, the indication was aesthetic augmentation (n=13). Both silicone (n=11) and saline (n=7) implants with different surfaces (smooth n=3, textured n=3, polyurethane n=1) were used. Symptoms such as unilateral swelling (n=18), pain (n=14) and erythema (n=5) occurred on an average of 23±9 years after implantation. Imaging showed fluid collection (n=8) or a tumour mass (n=4) around the breast implant. The most common surgical treatment was explantation with capsulectomy. Metastasis was described in 6 cases.</p><p><strong>Conclusions: </strong>BIA-SCC is a malignant tumour entity associated with breast implant capsules. Based on current low-quality data (level of evidence class V), no definitive conclusion regarding correlation and causality of SCC in patients with breast implants can be drawn. There is an urgent need for national and international breast implant and breast cancer registries to obtain valid data on the incidence, pathogenesis and clinical presentation of rare tumour entities.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10357471","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}