Handchirurgie, Mikrochirurgie, plastische Chirurgie [journal]
- [A Rare Case in Hand Surgery: Adder Bite in an Index Finger]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Handchir Mikrochir Plast Chir 2016 Jul 21.
The common European adder is an endangered animal species in Europe. Despite its endangerment, snake bite injuries do occur from time to time, even in Germany. This is a poisoning emergency. Detailed numbers concerning the incidence or lethality of adder bites in Germany do not exist. Only 13% of all cases have a severe course of disease, with children and elderly people prevailing in this patient group. We report the benign course of an adder bite injury of the index finger of a 60-year-old zoologist, which healed completely under symptomatic treatment and surveillance without any operative intervention.
- [Extradigital Glomus Tumor]. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2016 Jul 11.
- Kongresskalender. [Journal Article]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):194.
- [Comparison of the Results of Lundborg's and Sirotakova's Resection-Suspension Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):161-7.
The aim of this prospective randomised study was to compare Sirotakova's and Lundborg's methods of resection-suspension arthroplasty using the abductor pollicis longus tendon in the surgical treatment of osteoarthritis of the trapeziometacarpal joint.Between 2009 and 2012, 38 patients (29 female, 9 male) with symptomatic trapeziometacarpal osteoarthritis (34% stage II, 58% stage III and 8% stage IV according to the Eaton-Littler classification) were randomly allocated to one of the surgical methods (mean age 62.7 years, range 43-85). Preoperatively, the following data were collected: pain intensity (Visual Analogue Scale, VAS; at rest: Lundborg 4.4±1.7; Sirotakova 4.6±2.1), strength (key pinch force Lundborg 8.1 kPa±6.6; Sirotakova 10.4 kPa±10.8), range of motion in the trapeziometacarpal joint (Lundborg 61.64±26.4; Sirotakova 46.67±25.6), Kapandji index (Lundborg 9.42±1.4; Sirotakova 9.33±1.5), distance between the base of the first metacarpal bone and the scaphoid bone as measured by standardised x-ray images (Lundborg 12 mm±1.5; Sirotakova 11.4 mm±3), DASH questionnaire (Lundborg 40.4±13.9; Sirotakova 49.9±23.5). A significant difference between the 2 groups was not found. Patients were examined 3 and 9 months postoperatively.Both resection-suspension arthroplasty procedures led to a statistically significant postoperative reduction of pain, a significant improvement in radial and palmar abduction, a significant gain in quality of life and significant asymptomatic proximalisation of the first metacarpal bone. There was no significant difference in postoperative strength.Both methods lead to reliable and satisfying results. Given our findings we cannot generally recommend one method over the other.
- [Nerve Tubes for the Repair of Traumatic Sensory Nerve Lesions of the Hand: Review and Planning Study for a Randomised Controlled Multicentre Trial]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):148-54.
Nerve tubes are used for bridging of short nerve gaps and for coating of primary end-to-end nerve sutures. This article provides an overview of available implants and their application. Also it presents a retrospective planning study aiming to determine the static 2-point discrimination after primary peripheral nerve repair with and without the use of a nerve tube. The results have been used to determine the sample size of a prospective randomised trial.54 peripheral nerve injuries of 41 patients were treated by primary end-to-end nerve sutures with or without the additional use of a nerve tube (n=28 and n=26, respectively). 38 digital nerves and 16 median and ulnar nerves were affected. Nerve tubes were used for the repair of 15 digital nerves and 13 median and ulnar nerves. Clinical follow-up was performed 46 months after surgery (patients without nerve tubes) and 18 months after surgery (patients with nerve tubes), respectively. Static 2-point discrimination (2PD) was measured by double-tip compasses (weight: 18 g) and patients were examined for clinical signs of neuroma. Further examinations included grip strength as a percentage value compared with the uninjured hand and, in case of finger injuries, the range of motion in the proximal and distal interphalangeal joints, Strickland score, DASH score and implant-associated complications.In patients with primary end-to-end sutures for finger injuries, there were no statistically significant differences between treatment with and without nerve tubes regarding 2PD, grip strength, DASH- or Strickland score. However, 2PD values of patients with nerve tubes had an increased spread. Average 2PD in digital nerves was 4.5 mm (3-15; SD: 3.9) without nerve tubes and 5.5 mm (3-15; SD: 5) with nerve tubes. Average 2PD after lesions of the median and ulnar nerves was 10 mm (3-15; SD: 5.9 and 5.4, respectively) in both groups.The additional use of a nerve tube showed no superiority in this planning study. The expected average 2PD is 5 mm after digital nerve injuries and 10 mm after lesions of the median or ulnar nerves.
- Results of the Treatment of Chronic, Refractory CRPS with Ketamine Infusions: a Preliminary Report. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):143-147.
Chronic, refractory complex regional pain syndrome remains very difficult to treat. A sub-anaesthetic low-dose ketamine has shown promise in advanced CRPS. We investigated the efficacy of ketamine in anaesthetic dosage in chronic, refractory CRPS patients that had failed available standard therapies. 5 female patients, aged a mean of 34 years with long-standing, a mean of 8 years', CRPS received ketamine in anaesthetic dosage over 10 days. The patients received 1-5 ketamine courses. The effect of gradual pain reduction was observed beginning on the 4(th)-5(th) day of treatment, associated with a decrease in the intensity of the allodynia (pain at light touch). No improvement in function (finger range of motion, grip strength) of the affected hands was noted in any patient. This beneficial analgesic effect was confined to 1.5-2.5 months after treatment and then pain relapsed to the baseline level. The results of this study show a short-term analgesic effect for this therapy, with no effect on movement and function of the affected limbs. Nevertheless, this method brings hope to the most severely ill patients who cannot be offered any other reasonable treatment option.
- [Prevalence and Co-prevalence of Complex Regional Pain Syndrome (CRPS) and Carpal Tunnel Syndrome (CTS) in Hand Rehabilitation]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):136-42.
In the current literature, there are reports of associations between complex regional pain syndromes (CRPS) and carpal tunnel syndromes (CTS). The aim of this study was to determine the prevalence of both disease patterns in hand rehabilitation patients and to investigate whether there is a correlation between CTS and CRPS. Furthermore, differences in the healing process of patients with and without additional CTS, and the effectiveness of the rehabilitative therapy for both diseases, were investigated.The computerised medical records of 791 patients in the years 2009-2015 who had been in hand rehabilitation were retrospectively analysed. At the beginning and end of rehabilitation, measurements were made of pain by visual analogue scales (VAS, 0-10), grip strength and finger mobility (mean distance from finger pulp to palmar D2-D5). The clinical course was statistically analysed. CRPS diagnosis was confirmed clinically by a pain therapist, CTS diagnosis was confirmed by neurological and neurophysiological examination. Surgical therapy was performed despite CRPS diagnosis.The prevalence of CRPS was 161/1000 and of CTS 62/1000; the co-prevalence of the 2 diagnoses was 24/1000 (p<0.0001). In the CRPS group, after a mean of 8 (1-21) weeks of rehabilitative therapy, mean pain was reduced from 5 (1-10) to 3 (0-9), grip strength improved from 10 (0-39)kg to 18.5 (2.5-45.5)kg and finger mobility increased from 2.9 (0-7.6)cm to 1.8 (0-7.8)cm. In the CRPS+CTS group, after a mean of 6.8 (3-23) weeks of rehabilitative therapy, mean pain was reduced from 5 (0-8) to 2.6 (0-5), grip strength improved from 9.7 (2.4-25.5)kg to 17.4 (0.9-47.4)kg and finger mobility increased from 2.7 (0-5.3)cm to 1.7 (0-5.3)cm. Improvement over the period of rehabilitation was significant in both groups, though the period of therapy was significantly shorter in the CRPS+CTS group.CRPS and CTS are often associated. Rehabilitative therapy was effective for CRPS- and CRPS+CTS patients.
- [Perioperative Anticoagulation in Elective Hand Surgery: A Literature Review]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):127-35.
This review highlights pathways regarding the handling of anticoagulation in elective hand surgery based on current literature.
- [A Simple Surgical Procedure to Correct Overlapping of the Fifth Toe in Children]. [Journal Article]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):188-90.
- [Treatment Methods for Patients with Dupuytren's Disease in Switzerland]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2016 Jun; 48(3):155-60.
The objective of this study was to investigate what treatment options are currently used in Switzerland for Dupuytren's disease. Furthermore, regional preferences and treatment differences based on surgeon experience were analysed.In this survey, an electronic questionnaire was sent to all members of the Swiss Society for Hand Surgery. Participants were asked to indicate their current treatment methods for Dupuytren's disease. In addition, 8 standard patient cases were presented to identify the preferred treatment option. Furthermore, sociodemographic data of the participants were gathered.In total, 70 questionnaires were completed, corresponding to a response rate of 34%. Fasciectomy is performed by 94% of participants, while 59% inject collagenase in certain cases, 40% perform open fasciotomy, and 24% carry out percutaneous needle aponeurotomy if the indication is given. 20% of responders offer one of these techniques, 50% offer 2, 23% offer 3, and 7% offer all 4 treatment techniques. In the case of isolated metacarpophalangeal joint contracture, 51% of participants inject collagenase, whereas fasciectomy is preferred for the treatment of proximal interphalangeal joint contractures or in cases of recurrence. In German-speaking Switzerland, the treatment strategy has changed towards applying collagenase injections in the past 5 years. In this part of the country, 83% of surgeons now use more collagenase than 5 years ago, whereas only 33% of surgeons in French-speaking Switzerland have changed their treatment strategy in favour of collagenase injections (p=0.027). Surgeons with less than 10 years of experience apply more collagenase than their more experienced colleagues (79 vs. 54%, p=0.131).In Switzerland, fasciectomy is the preferred option for treating patients with Dupuytren's disease. In recent years, however, collagenase injection has become more and more popular. More research is needed to define guidelines for the treatment of patients with Dupuytren's disease considering the effectiveness of the different treatment options and regional preferences.