Handchirurgie Mikrochirurgie Plastische Chirurgie最新文献

{"title":"[Peripheral Nerve Surgery].","authors":"Kai Megerle, Jörg Bahm","doi":"10.1055/a-2168-2239","DOIUrl":"10.1055/a-2168-2239","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 1","pages":"6"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177847","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":"[Neuralgic amyotrophy: an inflammatory neuropathy and its surgical treatment].","authors":"Peter Pöschl, Mirko Pham, Maria Teresa Pedro, Gregor Antoniadis","doi":"10.1055/a-2226-4260","DOIUrl":"10.1055/a-2226-4260","url":null,"abstract":"<p><strong>Background: </strong>Neuralgic amyotrophy (NA) is a monofocal or oligofocal inflammatory neuropathy whose incidence has been significantly underestimated. A connection between constrictions and torsions of peripheral nerves with this disease has been increasingly established in recent years. Modern imaging techniques such as high-resolution nerve ultrasound and MR neurography have contributed to a better understanding of the pathophysiology and a better assessment of the prognosis of the disease. This has led to the concept of treating patients with such focal changes surgically in order to improve the prognosis. This review presents current ideas on the pathophysiology, clinical presentation, diagnosis and treatment of the disease.</p><p><strong>Patients and methods: </strong>In a retrospective study, pre-, intra- and postoperative findings of 22 patients with 23 constrictions/torsions of peripheral nerves of the upper extremity were analysed. The patients underwent surgery at a nerve surgery centre over a period of 3.5 years (Dec. 2019-May 2023). The median nerve was most frequently affected (N=9), followed by the suprascapular nerve (N=6) and radial nerve (N=4). The axillary nerve (N=3) and the accessory nerve (N=1) were also involved. Surgical exploration revealed nerve torsions (N=9), nerve constrictions (N=5), fascicular torsions (N=12) and fascicular constrictions (N=9). Depending on the intraoperative findings, epineuriotomies (N=1), epi- and perineuriotomies (N=33), end-to-end sutures (N=2), and one epi- and one perineural suture were performed.</p><p><strong>Results: </strong>After an average follow-up of 10 months (3-28 months), 17 patients were re-examined. All of them reported a clear subjective improvement in motor deficits. Clinically and electromyographically, a reinnervation and significant increase in strength from a pre-existing strength grade of M0 to at least M3 in the vast majority of affected muscles was demonstrated in these patients.</p><p><strong>Summary: </strong>The incidence of NA continues to be underestimated and, in a significant proportion of patients, leads to permanent motor deficits, most likely due to constrictions and torsions of affected nerves. Surgical treatment is recommended as early as possible. Very good results can usually be achieved with epi- and perineuriotomy. In rare cases, end-to-end neurorrhaphy or nerve grafting is required.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"40-48"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565483","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":"[Rare Compression Syndrome of the Median Nerve due to a Supracondylar Humeral Process and a Ligament of Struthers].","authors":"Davide Tosin, Gregor Antoniadis, Christian Rainer Wirtz, Maria Teresa Pedro","doi":"10.1055/a-2234-4636","DOIUrl":"10.1055/a-2234-4636","url":null,"abstract":"<p><strong>Introduction: </strong>A supracondylar process is a bony spur on the distal anteromedial surface of the humerus, and it is considered an anatomical variant with a prevalence of 0.4-2.7% according to anatomical studies. In almost all cases, it is associated with a fibrous, sometimes ossified ligament, which extends from the supracondylar process to the medial epicondyle. This ligament is known in the literature as the ligament of Struthers, named after the Scottish anatomist who first described it in detail in 1854. In rare cases, the supracondylar process can be a clinically relevant finding as a cause of nerve compression syndrome. The median and ulnar nerve can be trapped by the ring-shaped structure formed by the ligament of Struthers and the supracondylar process.</p><p><strong>Case report: </strong>A 59-year-old patient with symptoms of a cubital tunnel syndrome and additional ipsilateral sensory deficits in his thumb was referred to our clinic. Electroneurography showed no signs of an additional carpal tunnel syndrome. Preoperative x-ray and CT scans of the upper arm revealed a supracondylar process, which led us to suspect an associated entrapment of the median nerve. An MRI scan of the upper arm showed a ligament of Struthers and signs of a related median nerve compression as we initially assumed. We performed a surgical decompression of the median nerve in the distal upper arm and of the ulnar nerve in the cubital tunnel. Intraoperatively, there was evidence of compression of the median nerve due to the supracondylar process and the ligament of Struthers. The latter was cleaved and then resected along with the supracondylar process. Three months after surgery, the patient had no motor or sensory deficits.</p><p><strong>Summary: </strong>The ring-shaped structure formed by the supracondylar process and ligament of Struthers represents a rare cause of compression syndrome of the median and ulnar nerve. Its incidence remains unknown so far. This anatomical variant should be considered a differential diagnosis in case of possibly related nerve entrapment symptoms after ruling out other, more frequent nerve compression causes. Moreover, the supracondylar process should be completely resected including the periosteum during surgery to minimise the risk of recurrence.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"101-105"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742728","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":"[Nerve Transfers in Children with Non-traumatic Amyoplasia]","authors":"Benedikt Schäfer, Justus P Beier, Jörg Bahm","doi":"10.1055/a-2240-4781","DOIUrl":"10.1055/a-2240-4781","url":null,"abstract":"<p><strong>Background: </strong>The treatment of obstetric brachial plexus palsy through primary reconstruction and nerve transfers has been established in the past decades. In the case of non-traumatic diseases that lead to flaccid paralysis and the inability to move the extremities, such as transverse myelitis (TM) or arthrogryposis multiplex congenita (AMC), which can have a wide variety of causes, the focus has been on rehabilitative therapy so far, while surgical interventions have been used to a lesser extent, e. g., in the form of osteotomies or muscle transfers. Our aim is to establish nerve transfers as a surgical option to improve mobility in non-traumatic amyoplasia.</p><p><strong>Patients: </strong>This work presents the needs-adapted treatment of a total of 23 patients (aged 4 months to 64 months, 18 with AMC and 5 with TM) using nerve transfers on the upper extremity.</p><p><strong>Results: </strong>We were able to show that early nerve transfers in the upper extremity enabled the reanimation of muscles in both AMC and TM.</p><p><strong>Conclusion: </strong>This work shows that the treatment of non-traumatic amyoplasia in children with selective nerve grafts is a successful method. Nerve transfers allow patients to gain or regain important functions for managing independent everyday life. The surgical methods have been established in the treatment of traumatic nerve injuries. They are well-known and can be carried out safely. We believe that this is an important treatment option for paediatric patients with paralysis associated with TM or AMC, which should also be known to the treating physicians.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"56 1","pages":"55-64"},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177849","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":"[Goal-setting in Plastic Surgery using the SMART principle].","authors":"Rafael G Jakubietz, Riccardo E Giunta, Michael G Jakubietz, Sarah König","doi":"10.1055/a-2157-0946","DOIUrl":"10.1055/a-2157-0946","url":null,"abstract":"<p><strong>Introduction: </strong>The process of continuous acquisition of surgical expertise is a key element in registrar training. The principle of active, self-directed learning, which is regularly applied in medical school, can also be used to gain surgical expertise in registrar training.</p><p><strong>Methods: </strong>Surgical training can be compared to acquiring expertise in music or sport, where both intellectual and manual capabilities are required. Specific training principles, including analysis, goal setting, practice and reflection on the process, are commonly encountered in these fields. Smart goal setting is preferred in order to ensure compliance and a successful strategy. This can also be used in plastic surgery training.</p><p><strong>Application: </strong>Surgical principles as well as partial or complete surgical procedures can be practiced using the smart principle. The fragmentation of a larger task into smaller units allows rapid acquisition of surgical expertise without impeding patient safety.</p><p><strong>Discussion: </strong>Surgical training today happens in a setting caught between economic and medicolegal challenges. The reduction of case load requires simulation practice as well as self-directed learning - which has been shown to improve outcomes. The smart principle allows distinct goal setting which can improve compliance of the student and increase success. As this form of learning is not intuitive to all individuals, supervisors and mentor can support trainees in the acquisition of surgical expertise using this principle.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"450-456"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429277","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":"[Black clothes make a difference - Physical properties of Black clothes in Burn Injuries caused by solar radiation].","authors":"Patrick Mandal, Peter Kronberger, Anton H Schwabegger, Christoph Tasch, Gerhard Pierer","doi":"10.1055/a-1988-1433","DOIUrl":"10.1055/a-1988-1433","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"466-469"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9522515","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":"[German Translation and Validation of the Patient-Oriented Questionnaire \"Thumb Disability Examination\" (TDX) for Specific Diagnosis and Follow-Up of Thumb Carpometacarpal Joint Osteoarthritis].","authors":"Sinan Mert, Iana Emelianova, Nicholas Möllhoff, Moritz Christian Bader, Riccardo Giunta, Elisabeth Maria Haas-Lützenberger","doi":"10.1055/a-2192-9410","DOIUrl":"https://doi.org/10.1055/a-2192-9410","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) are becoming increasingly important in today's patient care. Unfortunately, the most common PROMs in hand surgery are very time-consuming and usually do not cover the actual, diagnosis-specific complaints of the patients. For diagnosis and follow-up of thumb carpometacarpal joint osteoarthritis, Noback et al. developed and validated the Thumb Disability Examination (TDX) questionnaire. This 20-item questionnaire specifically assesses daily living limitations and pain as well as patient-reported satisfaction of thumb function. The aim of this study is to validate the German translation of the TDX, the Thumb Disability Examination - German (TDX-G), and to compare it with the German-language versions of the MHQ and qDASH, which are currently used as gold standard.</p><p><strong>Material und methods: </strong>Translation and back-translation were performed in accordance with accepted guidelines. For statistical validation of the TDX-G, 30 consecutive patients with thumb carpometacarpal joint osteoarthritis were interviewed under standardised conditions. Internal consistency was calculated using Cronbach's alpha. Test-retest reliability was determined in 10 patients who completed the TDX-G twice at an interval of 2 weeks. The validity of the TDX-G was determined by calculating the correlation coefficients of the TDX-G with the MHQ and qDASH, subjective pain sensation (NRS), and hand strength levels (coarse and pinch strength). In addition, the time to collect each questionnaire was compared.</p><p><strong>Results: </strong>The TDX-G has high internal consistency (Cronbach's alpha 0.932) and test-retest reliability (intraclass correlation coefficient 0.963 [0.850-0.991]). There is a significant correlation between TDX-G and MHQ (- 0.782; p<0.001) and qDASH (0.833; p<0.001). All questionnaires correlate significantly with pain on exertion and pinch force, with the TDX-G having the highest correlation in each case. Significantly less time is needed to record the TDX-G (110±28 s) than to record the MHQ (413±98 s).</p><p><strong>Conclusion: </strong>The TDX-G is a reliable tool for diagnosing and monitoring the progression of thumb carpometacarpal joint osteoarthritis. It can be used in both patient care and clinical research and accurately mirrors the symptoms.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":"55 6","pages":"443-449"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813675","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":"[The split turnover pectoralis muscle flap: an easy and safe method for sternal wound coverage].","authors":"Claas Spengler, Frank Masberg, Roland Mett","doi":"10.1055/a-2060-0814","DOIUrl":"10.1055/a-2060-0814","url":null,"abstract":"<p><p>The conventional pectoralis muscle flap is well known for the reconstruction of sternal defects after deep sternal wound infection. The pectoralis muscle flap can be harvested as an advancement flap based on the thoracoacromial artery, or it can be harvested as a turnover flap based on intercostal perforators of the internal thoracic artery. A disadvantage of the advancement flap can be seen in its limited reach, especially for covering the lower third of the sternum. The turnover flap is well suited for coverage of the lower and middle sternal third, but then lacks the length for coverage of the cranial third. The authors describe a new method for splitting up the pectoralis turnover muscle flap along its muscle fibres in order to gain additional length. Between 2017 and 2022, we treated 12 patients with this method. Total wound coverage and closure have been achieved in all 12 patients. Thus, the split turnover pectoralis flap is a safe and effective method for sternal wound treatment.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"437-442"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683797","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":"[Choice of flaps for phalloplasty: what is the contemporary standard? Consensus Statement of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels].","authors":"Lara Küenzlen, Jens Christian Wallmichrath, Markus V Küntscher, Jens Rothenberger, Christian Laback, Dirk Johannes Schaefer, Jürgen Schaff, Ahmet Bozkurt, Gabriel Djedovic, Stefan Langer, Tobias Hirsch, Ulrich Rieger","doi":"10.1055/a-2134-5891","DOIUrl":"10.1055/a-2134-5891","url":null,"abstract":"<p><p>The ever-expanding number of transmen as well as their surgeons share an increasing interest in the construction of a neophallus. While the indication for surgery and the positive effect of a phalloplasty on the quality of life, mental health and sexual function has already been thoroughly analysed, there is a lack of data comparing and evaluating the surgical steps. During the consensus conference on the \"choice of flaps for phalloplasty\" at the annual meeting of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels, the current literature was discussed and a consensus on the surgical technique of a phalloplasty was reached. This manuscript publishes jointly developed recommendations on the following topics: choice of flaps for phalloplasty, preoperative diagnostic tests before phalloplasty, urethral construction in the radial forearm flap and anterior lateral thigh flap, preformation of the urethra at the forearm or thigh, venous drainage of the radial forearm flap, innervation of the phallus, staged phalloplasty, coronaplasty and managing the donor site of a radial forearm flap.</p>","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"427-436"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41179453","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":"[Changes of the Impact Factor 2022].","authors":"Riccardo E Giunta","doi":"10.1055/a-2023-3845","DOIUrl":"10.1055/a-2023-3845","url":null,"abstract":"","PeriodicalId":55075,"journal":{"name":"Handchirurgie Mikrochirurgie Plastische Chirurgie","volume":" ","pages":"408-410"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650480","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}