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Handchirurgie, Mikrochirurgie, plastische Chirurgie [journal]
- [Amputation of the Hand due to Necrotising Fasciitis: A Case Report.] [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Apr 2.
We report the case of an 81-year-old woman who fell at home on her left hand and suffered a laceration of her forehead. Within days a fulminant necrotizing fasciitis of the hand from group A β-haemolytic streptococcus developed. Lacking an apparent local germ entry point at the hand, the infection was initially misinterpreted as compartment syndrome. The patient's life was saved by amputation of the hand.
- Complications in Tissue Expansion: An Updated Retrospective Analysis of Risk Factors. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Mar 6.
The technique of tissue expansion has been widely applied in plastic surgery since the 1980 s. Implantation in the lower limb region, external port placement, and young patient age were known as risk factors for complications. Over the years, surgical experience has increased along with improved patient management and expander manufacturing. The aim of this study was to identify possible changes in risk factors regarding complications in tissue expansion.A retrospective, single-institution large sample observational study over a 5-year period (2006-2010) was performed involving 481 tissue expanders in 344 patients. Patients underwent surgical treatment for resurfacing scar tissue in the scalp, face, neck, nose, and limbs, but not breast. In addition, the results are discussed based on a comprehensive review of the literature published between 1995 and 2009.Statistical analysis showed significant correlations between cheek and hematoma (P=0.0133), scalp and dehiscence (P=0.0139), number of expanders per region and leakage (P=0.0379), number of expanders per region and overall complications (P=0.0252). Factors such as gender, age, tobacco use, and repeated expander implantation had no significant influence on the incidence of complications. The lower extremity region and young patient age ceased to show a statistical correlation with complications. The number of expanders per region was identified as a risk factor that has been disregarded so far.Evidence suggests a recent change in risk factors for tissue expansion-related complications. Consideration of updated risk factors may help to further improve outcomes in tissue expansion.
- Does ultrasonography contribute significantly to the diagnosis of carpal tunnel syndrome? [Journal Article]
- Handchir Mikrochir Plast Chir 2014 Feb; 46(1):42-6.
Recent studies have demonstrated ultrasonography as a valuable tool for confirming the diagnosis of carpal tunnel syndrome. The objective of this study was to investigate sonographic parameters of the median nerve in patients diagnosed clinically with carpal tunnel syndrome.185 wrists in 185 patients, 149 women (81%) and 36 men (19%), with a mean age of 59 years, with the clinical diagnosis of carpal tunnel syndrome were examined sonographically. We measured cross-sectional area (CSA) of the median nerve at the forearm and at the carpal tunnel inlet, as well as the height (a-p dimension) of the nerve at the tunnel inlet and in the narrowest site in the carpal tunnel. Moreover, in all patients the severity of the disease was assessed by the Levine questionnaire.A significant variability of sonographic data characterizing the median nerve was found: the mean CSA at the tunnel inlet was 17.6 mm2 (range: 7-36) and height of the nerve at the tunnel inlet was a mean of 2.7 mm (range: 1.3-4.5). No correlation was found between sonographic data and severity of the syndrome as expressed by the Levine scores.Sonography of the median nerve contributes little to the diagnosis of a clinically relevant carpal tunnel syndrome and its routine use is not justified.
- [A 15-Year-Old Adolescent Presenting both Madelung Deformity with Vickers' Ligament and Additional Palmaris Profundus Muscle.] [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Feb 26.
The palmaris profundus muscle is a rare entity which has been mentioned in association with nerve compressions. Madelung deformity is based both on an osteochondral lesion of the distal radial physis and often on the Vickers' ligament which originates around the lunate and inserts proximally in the radial physis. A 15-year-old right-handed female adolescent suffered from symptomatic left-sided Madelung deformity with Vickers' ligament and additional palmaris profundus muscle.
- Response to the letter to the editor of P. Mahapatra. [Comment, Letter]
- Handchir Mikrochir Plast Chir 2014 Feb; 46(1):68.
- "The wide-awake approach" - just one step to a streamlined carpal tunnel release service. [Comment, Letter]
- Handchir Mikrochir Plast Chir 2014 Feb; 46(1):67.
- [In Process Citation]. [Journal Article]
- Handchir Mikrochir Plast Chir 2014 Feb; 46(1):65.
- [Bipartite carpal scaphoid with osteonecrosis of the proximal pole - differential diagnosis of pseudarthrosis]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Feb; 46(1):62-3.
We report on the case of a young patient with bipartite carpal scaphoid with osteonecrosis of the proximal pole. The important differentiation of this entity to the pseudarthrosis of the scaphoid is discussed.
- [Infection of the hand: evaluation of a two-stage therapy]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Feb; 46(1):49-55.
Infections of the hand are common diseases in hand surgery departments. The correct diagnosis and subsequent treatment is difficult and is often underestimated. In literature different and often conflicting treatments are recommended. The present study retrospectively analysed our two-stage surgical treatment.60 patients (mean age: 51 years, 38 male, 22 female) were studied retrospectively on the basis of the diagnosis hand infection (ICD L03.-). In all patients, a rapid and radical surgical debridement without wound closure was performed. An antibiotic therapy was initiated. We investigated how often wound closure during a second-look operation, following a period of open wound treatment with antiseptic dressing was successful possible. Furthermore, the patients were followed up in our outpatient clinic.A successful secondary wound closure was possible after on average 38.7 h and in 92% of the patients. 8% of patients required further surgical treatment. These patients presented with either an existing disease or a delayed presentation with initial antibiotic treatment. Antibiotic therapy was performed on an average for 8.7 days. Altogether for 85% of the 58 patients examined in our outpatient clinic the therapy could be terminated after 3 weeks with a full recovery of function of the injured hand and with full force measurements. The inability to work was on average 16 days.The two-stage surgical treatment, with radical debridement and open wound dressing in our collective is an adequate treatment for infections of the hand. It is a safe procedure, that allows for combination with an antibiotic therapy by which a rapid restoration of function of the injured hand is possible.