Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

{"title":"[A child's severe injury of the palm hand - challenges and opportunities].","authors":"Eva K Kupczyk, Rafael G Jakubietz, Mila M Paul, Susanne Schäfer, Stefanie Hölscher-Doht","doi":"10.1055/a-2234-0049","DOIUrl":"10.1055/a-2234-0049","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"388-391"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302138","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":"[Anatomical Identification and Possibilities of Transfer of the Masseteric Nerve for Facial Reanimation].","authors":"Niclas Voraberger, Matthias Rab, Karoline Schwendt, Wolfang J Weninger, Maximilian Neuwirth","doi":"10.1055/a-2297-7777","DOIUrl":"10.1055/a-2297-7777","url":null,"abstract":"<p><strong>Background: </strong>The masseteric nerve (MN) is often used as a donor nerve for facial reanimation. In addition to already established techniques, MN transfer is rapidly gaining importance, mainly due to the single-stage approach of the procedure and its reconstructive potential. This anatomical study and the associated questionnaire study aimed to evaluate the established methods for identification of the MN and its suitability for direct nerve transfer as well as to assess the importance of MN transfer in the daily clinical routine.</p><p><strong>Material and methodology: </strong>Bilateral dissection of 25 fresh-frozen head specimens (n=50; 13 female, 12 male) was performed with accompanying measurement of the MN. In a questionnaire study conducted at established centres for facial surgery in German-speaking countries, clinical experience data of MN transfer was collected using the SurveyMonkey software. The data obtained was statistically analysed using Microsoft Excel and presented in numerical tables and boxplots.</p><p><strong>Results: </strong>Using anatomical landmarks such as the zygomatic arch and the mandibular notch for orientation, the MN was found in 100% of cases. Its average length from the emerging point below the zygomatic arch towards its entry into the masseter muscle was measured to be 22 mm and was the length available for nerve transposition. Tension-free coaptation of the MN with the zygomatic branch was possible in 94% of cases. The questionnaire showed that the MN is considered an important donor nerve for motor nerve transfers and that MN transfer is now largely established as a standard procedure.</p><p><strong>Discussion: </strong>In accordance with previously published studies, the MN was reliably found at the height of the mandibular notch and, in the vast majority of cases, was suitable for tension-free coaptation with the zygomatic branch. Differences to the existing literature, however, can be seen in the length of the nerve available for nerve transposition and the frequency of its division into several branches before entering the masseter muscle. In German-speaking countries, Cross-Face Nerve Grafting (CFNG) is still the preferred method for facial reanimation surgery. However, MN transfer is also well established by now, both as an alternative and a supplement to other techniques, possibly due to its low donor site morbidity and short time to regeneration.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"301-307"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076979","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":"[Recurrence of a Desmoid Tumour in a Scar at the Donor Site of a Latissimus Dorsi Flap].","authors":"Hazem Abdu, Can Cedidi","doi":"10.1055/a-2231-6343","DOIUrl":"10.1055/a-2231-6343","url":null,"abstract":"<p><p>A desmoid tumour, also known as aggressive fibrous tumour or desmoid fibromatosis, is a rare, benign tumour originating from connective tissue cells. Desmoid tumours account for approximately 0.03+% of all neoplasms and less than 3+% of all soft tissue tumours. The estimated incidence in the general population is 2 to 4 cases per million people per year [1]. Desmoid tumours are characterised by aggressive growth but typically do not metastasize. They often occur in young adults and preferably affect specific body regions such as the abdomen, shoulder, chest, or extremities. The exact cause of the condition is not fully understood, but genetic changes and hormonal factors may play a role. Symptoms of a desmoid tumour depend on its location and size, with pain, swelling, or restricted movement commonly occurring. A diagnosis is typically made through a tissue sample (biopsy) and imaging techniques such as MRI or CT [2]. To our knowledge, this is the first documented case of recurrence of a desmoid tumour in the scar at the donor site of a latissimus dorsi flap previously used for the reconstruction of desmoid resection in the lower leg.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"316-320"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693606","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":"[Ban on New year's Fireworks Reduces Severe Hand Injuries: A Nationwide Multicentre Study On The Prohibition Of Pyrotechnics Due To Covid-19 Restrictions].","authors":"Wolfram Demmer, Irene Mesas Aranda, Marcela Jimenez-Frohn, Tobias Esser, Simon Oeckenpöhler, Henrik Lauer, Riccardo E Giunta, Elisabeth Maria Haas-Lützenberger","doi":"10.1055/a-2322-1414","DOIUrl":"10.1055/a-2322-1414","url":null,"abstract":"<p><strong>Background: </strong>Injuries caused by explosions or pyrotechnic devices can lead to severe hand injuries with potential long-term consequences for both the affected individual and the healthcare system. The implementation of a nationwide ban on fireworks during the New Year festivities was only temporarily enforced as part of the protective measures during the Covid-19 pandemic. These two exceptional years provide an opportunity for evaluation as a model experiment to demonstrate the impact of a fireworks ban on the frequency of explosion-related hand injuries.</p><p><strong>Materials and methods: </strong>In a multicentre study, five German hand trauma centres retrospectively collected and analysed all pyrotechnic-related injuries that occurred within seven days around the New Year celebration between 2017 and 2023.</p><p><strong>Results: </strong>Severe hand injuries from explosions were significantly less frequent at New Year celebrations during the pandemic period compared with data collected in the years before and after Covid-19. After the return to regular sales laws and celebrations in December 2022, a significant increase in injuries was observed, surpassing even the pre-Covid period. Epidemiological data confirmed a high proportion of minors and male victims. The highest number of injuries was observed on New Year's Eve and the first day of January, with adults mainly being injured during the festivities, while children and adolescents were mainly injured during the first days of January.</p><p><strong>Conclusions: </strong>A national ban proved to be an effective method to prevent severe hand injuries caused by explosive devices and their lifelong consequences. The data obtained in this multicentre study can serve as a basis for informed policy action.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"308-315"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447616","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":"[Two-stage microsurgical soft tissue reconstruction of a complex sacral wound using an arteriovenous loop].","authors":"Benjamin Geber, Kristina Landscheidt, Ole Goertz, Jochen-Frederick Hernekamp","doi":"10.1055/a-2246-2116","DOIUrl":"10.1055/a-2246-2116","url":null,"abstract":"<p><p>The surgical reconstruction of sacral soft tissue defects is challenging, and complications are frequent. We report a successful two-stage three-dimensional microsurgical soft tissue reconstruction of a wide and deep sacral defect anastomosing a free combined ALT/TFL/rectus femoris flap to an ipsilateral vena saphena magna arteriovenous loop which was applied primarily. This case shows that complex microsurgical procedures can be promising in this demanding patient population if the indication is correct and the operative/perioperative strategy is clear.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"286-290"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112263","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":"[Coverage of complex pararectal pelvic defects: role of the free myocutaneous musculus vastus lateralis flap].","authors":"Wolfram Demmer, Verena Alt, Sinan Mert, Tim Nuernberger, Nikolaus Wachtel, Konrad Karcz, Riccardo E Giunta, Denis Ehrl","doi":"10.1055/a-2288-5141","DOIUrl":"10.1055/a-2288-5141","url":null,"abstract":"<p><strong>Background: </strong>In the event of an advanced rectal carcinoma, an evisceration with rectal amputation may become necessary. The resulting defects, due to their extent, depth, or local tissue damage from previous surgeries and radiation, can in many cases only be closed through free microvascular tissue transfer. In this case series, we demonstrate the successful combination of a musculocutaneous musculus vastus lateralis flap (MVL) with a direct connection to the superior gluteal artery.</p><p><strong>Materials and methods: </strong>Over a 47-month period, we retrospectively examined 11 cases of patients with dorsal pelvic defects after evisceration and rectal amputation that could not be closed using local or regional means. In cases of extensive defects with deep pararectal wound cavities, all these patients underwent defect coverage through a free myocutaneous MVL flap with a direct vascular anastomosis to the superior gluteal vessels.</p><p><strong>Results: </strong>The mean defect size was 290.0 cm² (SD: 131.2; range: 200-600 cm²). The mean defect depth was 10.5 cm, necessitating MVL flap reconstruction with an average size of 336.3 cm². Three operative revisions were required due to postoperative bleeding. There were no arterial or venous thromboses, and no flap loss occurred. Only one necrosis of a distal flap tip was observed, which could be corrected secondarily by direct suturing. The case-mix evaluation yielded an average value of 24.251 (SD: 21.699; range: 7.036-65.748) points, emphasizing the complexity of the cases.</p><p><strong>Conclusions: </strong>Our results indicate that a free microvascular MVL flap is a viable therapeutic option for pararectal defects that cannot be closed by local or regional methods. The superior gluteal artery proves to be a safe and sufficient vascular connection. In combination, even extensive defects can be successfully closed.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"279-285"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873630","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":"[Sequential Chimeric Osteocutaneous DCIA-Perforator-SIEA Flap to Reconstruct an Osteocutaneous Defect in the Lower Extremity and the Importance of Preserving the Ascending Branch - A Case Report].","authors":"Sandra Scharfetter, Elisabeth Russe, Georg Eder, Karl Schwaiger, Julia Maria Puchner, Gottfried Wechselberger","doi":"10.1055/a-2246-2190","DOIUrl":"10.1055/a-2246-2190","url":null,"abstract":"<p><strong>Background: </strong>The deep circumflex iliac artery (DCIA) perforator flap is an established method to reconstruct osteocutaneous defects. However, the cutaneous perforators come with a great anatomic variability. To deal with this problem, we used a sequential chimeric osteocutaneous free flap for reconstruction.</p><p><strong>Patients and methods: </strong>A 58-year-old man presented with an open tibial fracture after an avalanche accident resulting in an extended osteocutaneous defect in the lower extremity. The injury required osteocutaneous free flap coverage. We reconstructed the defect with a sequential chimeric osteocutaneous DCIA-perforator-SIEA flap.</p><p><strong>Results: </strong>The preservation of the ascending branch of the deep circumflex iliac vessels offered us the possibility to effectively cover an extended osteocutaneous defect in the lower extremity with a sequential chimeric osteocutaneous DCIA-perforator-SIEA flap. In our patient, the sequential chimeric osteocutaneous DCIA-perforator-SIEA flap healed without complications. A small hernia developed at the inguinal donor site area, but it healed without further complications after surgical treatment. The patient regained an adequate function and returned to daily life and physical exercise.</p><p><strong>Conclusion: </strong>While preparing the DCIA-perforator free flap, it is important to preserve the ascending branch of the deep circumflex iliac vessels and the vessels needed to harvest either a SIEA or SCIP flap.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"321-326"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742727","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":"[Evidence of modern diagnostic, conservative, and surgical therapy of secondary lymphoedema].","authors":"Patrick Will, Adrian Dragu, Joachim Zuther, Jörg Heil, De-Hua Chang, Jürg Traber, Christoph Hirche","doi":"10.1055/a-2322-1325","DOIUrl":"10.1055/a-2322-1325","url":null,"abstract":"<p><strong>Background: </strong>Secondary lymphoedema (SL) is one of the most common and, at the same time, most significant consequences and complications of modern oncological therapy. Although a thorough patient history and physical examination are sufficient to substantiate a suspicion, it is essential to perform functional imaging of the lymphatic system for a targeted diagnosis and determination of severity. For this purpose, techniques such as MR and ICG lymphography as well as ultra-high-frequency ultrasound examinations have been developed and validated in recent years. The selective use of these techniques has allowed for individualized indications and successful stage-dependent treatment using (super)microsurgical techniques to restore regional lymphatic drainage in the context of intensified conservative therapy.</p><p><strong>Method: </strong>Systematic review of the literature on the diagnosis and treatment of SL with subsequent analysis and classification of the results into evidence levels according to the Oxford Centre for Evidence-Based Medicine and the GRADE Scale.</p><p><strong>Results: </strong>The established and validated diagnosis of SL includes imaging (ICG fluorescence lymphography, MR lymphography and Tc-99 functional lymphoscintigraphy) in case of a clinical suspicion and in high-risk patients. Complex physical decongestion therapy (CPE) is superior to physical therapy or compression alone. (Super)microsurgery of SL allows for a postoperative reduction in the frequency of CPE, a reduction of erysipelas rates, a volume reduction of the lymphomatous extremity and, if carried out prophylactically, a lower incidence of SL. Suction-assited lipectomy can produce long-term, stable reductions in circumference and an improvement in quality of life.</p><p><strong>Conclusion: </strong>Patients with SL benefit from conservative therapy with regular re-evaluation. Patients with a high risk for SL or with clinical deterioration or persistent symptoms under guideline-based conservative therapy can benefit from (super)microsurgical therapy after an individualized functional diagnostic evaluation of the lymphatic system. Excisional dermolipectomies or lympholiposuctions are available and effective for advanced and refractory stages.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"291-300"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447617","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":"[Reconstruction of Oncological Defects in the Pelvic-perineal Region: Report on the Consensus Workshop at the 44th Annual Meeting of the DAM 2023 in Bern, CH].","authors":"Elisabeth A Kappos, Séverin R Wendelspiess, Julia Stoffel, Gabriel Djedovic, Ulrich M Rieger, Holger Bannasch, Elmar Fritsche, Mihai Constantinescu, Mihailo Andric, Roland S Croner, Volker J Schmidt, JanA Plock, Dirk J Schaefer, Raymund E Horch","doi":"10.1055/a-2358-1479","DOIUrl":"https://doi.org/10.1055/a-2358-1479","url":null,"abstract":"<p><p>The surgical-oncological treatment of pelvic and perineal malignancies is associated with a high complication rate and morbidity for patients. Modern multimodal treatment modalities, such as neoadjuvant radio-chemotherapy for anal or rectal cancer, increase the long-term survival rate while reducing the risk of local recurrence. Simultaneously, the increasing surgical radicality and higher oncological safety with wide resection margins is inevitably associated with larger and, due to radiation, more complex tissue defects in the perineal and sacral parts of the pelvic floor. Therefore, the plastic-surgical reconstruction of complex pelvic-perineal defects following oncological resection remains challenging. The reconstructive armamentarium, and thus the treatment of such defects, is broad and ranges from local, regional and muscle-based flaps to microvascular and perforator-based procedures. While the use of flaps is associated with a significant, well-documented reduction in postoperative complications compared to primary closure, there is still a lack of reliable data directly comparing the postoperative results of different reconstructive approaches. Additionaly, the current data shows that the quality of life of these patients is rarely recorded in a standardised manner. In a consensus workshop at the 44^th annual meeting of the German-speaking Association for Microsurgery on the topic of \"Reconstruction of oncological defects in the pelvic-perineal area\", the current literature was discussed and recommendations for the reconstruction of complex defects in this area were developed. The aim of this workshop was to identify knowledge gaps and establish an expert consensus to ensure and continuously improve the quality of reconstruction in this challenging area. In addition, the importance of the \"patient-reported outcome measures\" in pelvic reconstruction was highlighted, and the commitment to its widespread use in the era of value-based healthcare was affirmed.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 4","pages":"269-278"},"PeriodicalIF":0.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977313","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":"[Rhizarthrosis: Resection Arthroplasty versus Resection Suspension Arthroplasty - Still the Gold Standard?]","authors":"Saskia Carolin Tosun, Leonie Barbara Pietzsch, Manuel Held, Adrien Daigeler, Wiebke Eisler","doi":"10.1055/a-2231-2279","DOIUrl":"10.1055/a-2231-2279","url":null,"abstract":"<p><p>Rhizarthrosis is one of the most common arthritic changes in the hand, which has led to the development of a large number of surgical methods in recent years. In addition to the traditional resection arthroplasty with tendon suspension or interposition, if needed, thumb saddle joint prostheses are being used more and more frequently. However, these are not an option for all patients such as those with severe osteoporosis, severe nickel allergy, insufficient height of the trapezium or STT osteoarthritis. This study examined whether the traditional surgical methods continue to have their \"right to exist\" or whether they will be replaced by prostheses. In a retrospective study with prospective data collection, 48 hands of 45 patients diagnosed with rhizarthrosis in stages II and III according to Eaton and Littler were clinically examined 2.5 years after resection arthroplasty/resection-suspension-interposition arthroplasty using flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strips in the years 2015-2018. The postoperative outcome was assessed using mobility, grip strength, two-point discrimination, postoperative satisfaction with regard to pain and resilience, as well as the DASH and MHQ questionnaires. There were no significant differences in surgery duration, inability to work, time to full weight-bearing, pain, satisfaction, grip strength and mobility. Regardless of the surgical method used, patients achieved an almost free range of motion in the thumb and wrist as well as age-appropriate hand strength. Pain at rest was rare; 48% were pain-free during exercise. The DASH questionnaire scored 20.2, 13.9 and 22.1 points and the MHQ scored 76.3, 79.3 and 79.4 points. Hence, the traditional surgical techniques showed good postoperative results with high patient satisfaction. \"Newer procedures\" such as endoprosthesis offer promising results in terms of faster regeneration times. However, this is offset by a longer surgery time and higher material costs, which means that resection arthroplasty represents a long-established procedure with a low potential for complications and a lower revision rate and should continue to be used, especially if there are relative contraindications to an endoprosthesis.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"219-226"},"PeriodicalIF":0.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177841","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}