Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

{"title":"[Two-Stage Reconstruction in Bony Finger Joint Defects - Long-Term Results].","authors":"Richard-Tobias Moeller, Martin Mentzel, Daniel Vergote, Simon Bauknecht","doi":"10.1055/a-2204-7599","DOIUrl":"10.1055/a-2204-7599","url":null,"abstract":"<p><strong>Background: </strong>Bony defects in finger injuries and infections impose high demands on their treatment due to the close anatomic relationships. Ideally, the injuries are entirely treated in emergency care. Due to the mechanism of the accident, contaminated and compromised soft tissues are often present and set limits to single-stage treatment. We present the long-term subjective and functional results after two-stage reconstruction of bony finger joint defect injuries.</p><p><strong>Patients and methods: </strong>Over a period of 15 years, a total of 40 patients with 43 fingers were treated due to a defect injury in the phalanges. Initially, the finger was stabilised with Kirschner wires after debridement. After consolidation of the soft tissue, the bone was reconstructed in a subsequent operation by interposition of an iliac crest graft. Complications occurred in 9 patients. Twenty-five patients with 27 fingers were followed up for 10.3 years. Range of motion, length of the affected finger, and grip force, each in relation to the contralateral extremity, were recorded. In addition to a subjective assessment of the global result, the daily function was determined by means of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.</p><p><strong>Results: </strong>Significant differences compared with the contralateral extremity (p<0.05) were found in length (70 mm; 91.0%) and total mobility of the affected finger (95°; 46.0%), hand span when the thumb was involved (202.5 mm; 93.4%), and power grip when one of the fingers was injured (30 kg; 84.1%). The DASH score was 4.2 points (0-55.8). Subjectively, 88% of patients were satisfied with the treatment outcome.</p><p><strong>Conclusion: </strong>In case of contaminated and compromised soft tissues, the two-stage treatment of bony defect injuries in finger joints by arthrodesis of the joint is a reliable treatment strategy. In the long run, it results in a very satisfactory function of the hand in everyday life although significant differences have been measured compared with the contralateral extremity.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"227-234"},"PeriodicalIF":0.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873471","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 Burn Shock - The First 24 hours and Beyond].","authors":"Dorothee Böhm, Björn Bliesener, Thorben Dieck, Marianne Kruse, Tobias Odenthal, Christian Stoppe, Stefan Trojan, Jochen Gille","doi":"10.1055/a-2208-8107","DOIUrl":"10.1055/a-2208-8107","url":null,"abstract":"<p><p>Acute phase and resuscitation after burn trauma are challenging even for specialised burn centres due to the individual onset and differences compared with other forms of shock. The guidelines of the German Society of Burn Medicine (DGV) cover the scientific basis of modern burn treatment. Nevertheless, uncertainty remains regarding the detailed practical handling. This expert consensus focuses on best practices for the treatment of patients with major burns in specialised burn centres and by clinical first responders. The short version of this expert consensus can be downloaded at: https://verbrennungsmedizin.de/files/dgv_files/pdf/positionspapier/Pos%20Therapie%20des%20Verbrennungsschock%20AK%20Intensivmedizin%202023.pdf.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"166-171"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984613","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":"[Stewart-Treves Syndrome as a Rare, but Fatal Complication of Peripheral Lymphedema].","authors":"Rima Nuwayhid, Stefan Langer, Torsten Schulz","doi":"10.1055/a-2084-0823","DOIUrl":"10.1055/a-2084-0823","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"180-183"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10005378","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":"[Robotic-assisted harvesting of a latissimus dorsi muscle flap: a case report].","authors":"Denis Ehrl, Tim Nuernberger, Christian Stief, Konrad Karcz, Riccardo E Giunta","doi":"10.1055/a-2230-8679","DOIUrl":"10.1055/a-2230-8679","url":null,"abstract":"<p><p>Having established itself in various other areas of surgery as well as in urology, robotics is increasingly gaining importance in plastic surgery. The case presented in this manuscript describes the first published robotic-assisted harvesting of a latissimus dorsi muscle free flap in the German-speaking world. The aim is to increase the knowledge of robotics in plastic surgery and to support the introduction of robotic-assisted plastic surgery in Germany.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"141-146"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029571","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":"[Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: Case Report, Technical Aspects and Identification of Suitable Patients].","authors":"Ayla Antonia Hohenstein, Daniel Kraus, Johannes Zeller, Laura Anna Schneider, Nikolaos Liakos, Christian Gratzke, Ingolf Juhasz-Böss, Steffen Eisenhardt","doi":"10.1055/a-2239-6513","DOIUrl":"10.1055/a-2239-6513","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted harvest of the deep inferior epigastric perforator (DIEP) flap is an innovative modification of the traditional open preparation for autologous breast reconstruction. It is assumed that donor-site morbidity (herniae, bulging) is reduced by minimising the fascial incision length in robotic-assisted DIEP flap harvest.</p><p><strong>Material & methods: </strong>This is the first report of a robotic-assisted DIEP harvest in Germany, which was performed in April 2023 at the University Hospital of Freiburg in an interdisciplinary approach of the Departments of Plastic Surgery, Urology and Gynaecology. To determine the value of this novel technique, we assessed the demand by retrospectively performing an analysis of potential patients and conducted a cost analysis based on the breast reconstructions with DIEP flap harvest performed between April 2021 and May 2023 at the Department of Plastic Surgery at Freiburg University Hospital. To this end, we carried out a retrospective analysis of preoperative CT angiographies to determine the proportion of patients suitable for a robotic-assisted procedure in a post-hoc analysis. Furthermore, we describe the basic robotic-assisted techniques and discuss the TEP and TAPP laparoscopic approaches.</p><p><strong>Results: </strong>In line with the previously published literature, a short intramuscular course (≤25 mm) and a perforator diameter of≥1.5 mm and≥2.7 mm (subgroup) were defined as a crucial condition for the robotic-assisted procedure. We analysed 65 DIEP flaps harvested in 51 patients, of which 26 DIEP flaps in 22 patients met both criteria, i. e.≤25 mm intramuscular course and≥1.5 mm diameter of the perforator, while 10 DIEP flaps in 10 patients additionally met the criteria of the subgroup (≥2.7 mm diameter). Based on the intramuscular course of the perforators in the CT angiographies of those 26 DIEP flaps, a potential reduction of the fascial incision of 96.8±25.21 mm (mean±standard deviation) compared with the conventional surgical approach was calculated. The additional material costs in our case were EUR 986.01. However, ischaemia time was 33,5 minutes longer than the median of the comparative cohort.</p><p><strong>Conclusion: </strong>The robotic-assisted procedure has already proven to be a feasible alternative in a suitable patient population. However, further studies are needed to confirm that robotic-assisted DIEP flap harvest actually reduces harvest site morbidity and thereby justifies the additional costs and complexity.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"147-155"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991947","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":"Correction: Robotic-Assisted Anastomosis in Orthoplastic Surgery: Preliminary Data.","authors":"Francesco Mori, Giulio Menichini, Francesco Rizzo, Paolo Sassu, Marco Innocenti","doi":"10.1055/a-2310-5248","DOIUrl":"https://doi.org/10.1055/a-2310-5248","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 2","pages":"e1"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873631","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":"[Robotic-Assisted Lymphatic Surgery].","authors":"Lisanne Grünherz, Donata von Reibnitz, Nicole Lindenblatt","doi":"10.1055/a-2254-7045","DOIUrl":"https://doi.org/10.1055/a-2254-7045","url":null,"abstract":"<p><p>Surgical robotic systems specifically developed for microsurgery are increasingly being used in recent years, particularly in reconstructive lymphatic surgery. Currently, there are two robotic systems that are used in microsurgery. Both systems feature tremor reduction and motion scaling technologies, which are intended to optimise the surgeon's precision and dexterity. In the Department of Plastic Surgery and Hand Surgery at the University Hospital Zurich, the Symani Surgical System is used in many microsurgical and supermicrosurgical procedures. It is mainly used in reconstructive lymphatic surgery, especially for robotic-assisted lymphovenous anastomosis, microvascular anastomosis of lymph node flaps, and it is used in central lymphatic surgery. The robot enables smaller surgical approaches for deep anatomical structures with enhanced surgical precision. In combination with an exoscope, it can also improve the ergonomics of the microsurgeon.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 2","pages":"122-127"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872078","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":"[Robot-assisted Microsurgery in Lower Extremity Reconstruction].","authors":"Felix Strübing, Arne Böcker, Amir K Bigdeli, Emre Gazyakan, Julian Vogelpohl, Jonathan Weigel, Ulrich Kneser, Felix H Vollbach","doi":"10.1055/a-2264-6866","DOIUrl":"10.1055/a-2264-6866","url":null,"abstract":"<p><strong>Background: </strong>In recent years, various robotic systems specifically designed for microsurgical tasks have been developed and approved. There is not much evidence for these systems to date. In our study, we examined the use of robot-assisted microsurgery in the reconstruction of the lower extremity.</p><p><strong>Patients/material and methods: </strong>Data was prospectively collected between February and November 2023. The Symani robotic system was used in 42 robot-assisted microsurgical procedures on the lower extremity, and the results were evaluated and documented.</p><p><strong>Results: </strong>The average age of the patients was 57±18 years. A total of 39 free flap reconstructions (95%), one lymphatic surgical procedure (3%) and two nerve transfers (5%) were performed. In total, 46 anastomoses and coaptations were carried out. This included six arterial end-to-end anastomoses (11%), seven arterial end-to-side anastomoses (13%), 36 venous end-to-end anastomoses (65%), two lymphovenous anastomoses (4%), and five epineural coaptations in the context of nerve transfers (9%). Arterial end-to-end anastomoses took an average of 26±12 minutes, and arterial end-to-side anastomoses took 42±21 minutes. The venous anastomoses took an average of 33±12 minutes. Epineural coaptations took an average of 24±13 minutes. In no procedure was there a need for a conversion to conventional hand suturing. There were two arterial thromboses (5%), one of which was successfully revised to save the flap. One total flap loss occurred, but there were no partial flap losses.</p><p><strong>Conclusion: </strong>Using the Symani robotic system for microsurgical reconstruction of the lower extremity, we were able to demonstrate results that are comparable to conventional microsurgery.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"128-134"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190437","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":"[Robotic-assisted microsurgery ̶ a new innovation boost for reconstructive microsurgery?]","authors":"Riccardo Giunta","doi":"10.1055/a-2267-9215","DOIUrl":"10.1055/a-2267-9215","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"112-113"},"PeriodicalIF":0.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319942","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":"Robotic-Assisted Anastomosis in Orthoplastic Surgery: Preliminary Data.","authors":"Francesco Mori, Giulio Menichini, Francesco Rizzo, Paolo Sassu, Marco Innocenti","doi":"10.1055/a-2285-4597","DOIUrl":"https://doi.org/10.1055/a-2285-4597","url":null,"abstract":"<p><strong>Background: </strong>The evolution of microsurgery has relied on advancements in operating microscopes and surgical instruments. Pioneering advancements, however, especially within the domain of \"super-microsurgery\", challenge the limits of human dexterity by dealing with anastomoses between vessels smaller than 0.8 mm. Based on these premises, the Symani robotic system was designed and developed. This platform utilizes teleoperation and motion-scaled movement to provide surgeons with precision and accuracy in manipulating millimetre and submillimetre-sized anatomical structures. In this study, we present our experience in performing robotic-assisted anastomoses using the Symani Surgical System in free flap reconstruction.</p><p><strong>Methods: </strong>We present a comprehensive analysis of all reconstructive procedures involving microsurgical free flaps performed using the Symani robotic platform at the orthoplastic unit of the Rizzoli Orthopaedic Institute from 1 October 2022 to 1 May 2023.</p><p><strong>Results: </strong>Sixteen microsurgical reconstructions using free flaps were performed, involving a total of 40 anastomoses on vessel calibres ranging from 0.6 mm to 2.5 mm. In each case, the anastomosis was executed with the assistance of the robotic platform, achieving a 100+% success rate in patent anastomoses, and no major complications occurred.Conclusion The Symani system has proven to be safe and reliable in performing microsurgical anastomoses. While this platform demonstrated successful in various vessel calibres, its most promising potential lies in anastomoses below the size of a millimetre. Larger patient cohorts and extended investigation periods will be essential to explore whether robotics in microsurgery offers advantages across all microsurgical procedures or should be reserved for selected cases.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 2","pages":"135-140"},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873092","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}