M?glichkeiten und Ergebnisse der (freien) vaskularisierten Knochentransplantation im Handbereich

The vascularized bone transplantation or graft is a modern and successful treatment concept in segmental bone loss. Faster healing and higher union rates were shown in several studies. Using vascularized bone grafts, the adaption in mechanical conditions as well as stability are improved. The indications, however, must be critically considered in order to obtain an optimal result. Reconstruction of the bone defect should be performed as quickly as possible after the trauma, infection, or tumor resection. Amputation should always remain the method of last choice. Depending on the existing bone defect, there are various possible donor sites, e.g., fibula, scapula, ulna, femur, and hip bone. The advantages and disadvantages of each donor site has to be thoroughly discussed prior to the operation to assure an optimal postoperative result. In view of these issues, vascularized bone grafts should be performed in microvascular specialized plastic or hand surgery centers.     

Möglichkeiten und Grenzen der subtalaren Arthrorise im Kindesalter

The minimally invasive subtalar screw arthroereisis procedure is becoming an increasingly more established option for treating juvenile flexible flatfoot. The procedure is indicated in children who are 9–13 years old and have idiopathic juvenile flexible flatfoot that has progressed to a symptomatic pathology. Minimally invasive subtalar screw arthroereisis functions by a combination of mechanical and proprioceptive effects that allow for growth adjustment of the subtalar joint and with a low complication rate. This surgical intervention is contraindicated for treating fixed and secondary pes plano valgus. The subtalar screw is removed once the pediatric foot has stopped growing and results in permanent correction of the flexible flatfoot.     

Prinzipien und Möglichkeiten der Defektedeckung im distalen Unterschenkeldrittel und Sprunggelenkbereich

The lower leg is the most often severely injured part of the lower extremity. Despite improved operative techniques, soft tissue defects alone or in combination with bone defects that cannot be closed by secondary suture still present a complex diagnostic and therapeutic problem. Modern treatment of severe trauma to the distal lower leg requires a global defect management which is based on: 1) profound basic knowledge, 2) multidisciplinary treatment team using a “common language” concerning diagnosis, classification and treatment, and 4) an integrated treatment concept. Adequate primary defect reconstruction is the basis of any successful treatment. For function improvement a variety of secondary operations like muscle/tendon transfer, tenodesis, capsulodesis, arthrodesis or ultimatively free functional muscle transplantation alone or in combination are available. Moreover adjuvant procedures such as orthesis, orthopaedic shoes, etc. may be useful at any time of treatment.     

Grenzen und Möglichkeiten der Trachealplastik

Ohne ZusammenfassungMit 12 TextabbildungenMit freundlicher Unterstützung der Deutschen Forschungsgemeinschaft.     

Entwicklung und Möglichkeiten der Lappendeckung

Substance defects are particularly challenging for surgeons in terms of both technique and time. To avoid the destruction of underlying structures, prompt defect coverage is required. For this, extensive radical débridement of injured or infected structures is necessary, followed by defect reconstruction within 2–3 days. Occlusion dressings worn for a protracted period of time, in contrast, can lead to further necrosis from deeper structures and should only be used as a temporary measure. There are a number of local and free reconstructive flap procedures available for defects. Choosing the correct procedure depends on the size of the defect on the one hand, and on the advantages and disadvantages of the various procedures on the other. Moreover, the latter need to matched against the wishes of the patient. Finally, the level of experience, preference and training of the treating surgeon are decisive factors in the choice of treatment.     

M?glichkeiten und Ergebnisse der (freien) vaskularisierten Knochentransplantation im Ober- und Unterarmbereich

This article reports on our experience treating bone defects of the upper extremity with vascularized bone grafts. In consideration of the current literature and our own experience, free vascularized bone grafts provide the best possibility to treat extensive bone defects that involve soft tissue of the upper extremity. Alternative, less challenging methods show no explicit advantages. Complications occur more often and the duration of treatment is even longer compared to a microsurgical reconstruction performed by an experienced surgeon.     

Klinische Möglichkeiten zur Steuerung der Körpertemperatur

The constancy of body temperature (CBT) is a cornerstone of homeostatic, homothermic organisms and is essential for a regulated course of biochemical and biophysical reactions. Severe deviations from normothermia (36.8+/-0.4 degrees C) are life threatening and even a moderate perioperative reduction of the CBT is coupled with an increased morbidity and mortality especially in high-risk patients. The relevant factors are coagulation disturbances, increased infection rate and increased cardiac risk. Normothermia should be achieved by the consistent use of warmth-conserving measures. On the other hand, a deliberate reduction in temperature or induced hypothermia is a neuroprotective procedure, which offers a therapeutic option to minimize neuronal secondary damage after primary hypoxic-ischemic events as well as extending the neuronal tolerance to ischemia. Management includes the practice of cooling down to a defined temperature, rewarming as well as a differentiated control of various parameters. Furthermore, side-effects which increase in severity with decreasing temperature must be taken into consideration.     

Einsatzmöglichkeiten des freien lateralen Oberarmlappens zur Defektdeckung an Hand und Unterarm

Background

The purpose of this retrospective study was to verify the advantages and disadvantages of the free lateral arm flap for defect reconstruction of the forearm and hand.

Patients and methods

The data of 21 patients who underwent defect coverage of the forearm and hand with the free lateral arm flap between 2002 and 2010 were analyzed. The mean patient age was 48 years (range 17–78 years). The results concerning defect origin, flap size, pedicle length, operative time, revision of the anastomosis or other complications, donor site morbidity and length of hospital stay were evaluated.

Results

In 6 cases the defect was on the forearm and in 15 on the hand. The majority of defects were infections or chronic wounds. The overage flap width ranged from 3 to 8 cm and the length from 5 to 20 cm. Revision of the anastomosis was only necessary in one case and flap survival rate was 100%. In all patients primary closure of the donor site was possible without complications during the healing procedure.

Conclusion

The results underline the good reliability of the free lateral arm flap with a satisfactory aesthetic appearance excellent tissue quality and frequent primary donor site closure.     

Möglichkeiten und Grenzen der modernen Polyethylene

Background

Polyethylene is still one of the most important materials in the field of hip and knee arthroplasty. The clinical results of the last decades have helped to further develop polyethylene into a high-tech material. Progress in the development of new materials must be compared with the tried and tested ones to provide optimal and most individual patient care.

Objectives

This article gives an overview of the history and current application profile of the material ultra-high molecular weight polyethylene (UHMWPE) in hip and knee arthroplasty.

Material and methods

With the aid of the current literature, new developments in the field of the material UHMWPE, also with respect to the biological activity of wear, the particular biomechanics of the knee joint as well as alternative hard-hard bearing surfaces in the hip, are represented in terms of implant safety.

Results

The problems concerning polyethylene are now well recognized. The disadvantages of the material UHMWPE could be consistently reduced based on material research so that modern polyethylenes have gradually been shown in clinical trials that they can be reliably used.

Conclusion

Despite this the potential for improvement has still not yet been fully exploited. Any further development must be extensively tested both biomechanically and biologically before the material can be used in vivo. Long-term results are still necessary before a material can be accepted as being clinically safe.     

Möglichkeiten und Grenzen der schaftfreien Oberarmkopfprothese

Currently there are five manufacturers offering stemless implants for shoulder joint replacement. A total number of almost 10,000 stemless implants have been used in shoulder arthroplasty since 2004. There are two different types of metaphyseal anchorage, one obtained by impaction of a fin system and in the other implant system cage screw fixation is used. Regarding revision surgery the different types of implants show varying advantages and disadvantages in terms of secondary approach to the glenoid and the metaphyseal component. Because of the small number of cases and short period of observation at the present time none of the implant systems show a decisive superiority. In sclerotic bone the cage screw system seems to be advantageous whereas impaction using the fin system seems to be preferable in osteoporotic bone and conditions with defects of the bone. A prerequisite for all types of stemless shoulder implants is good quality bone. There should not be bony defects under the surface of the area of head resection. Stemless implants are not indicated for acute fractures.     

Photodynamische Therapie im Gastrointestinaltrakt Möglichkeiten und Grenzen

Background. Photodynamic therapy (PDT) is characterized by the extensive selective accumulation of a photoactive agent, the photosensitizer, in malignant or precancerous tumour cells. The photoactive compound is activated by light beam of a specific wavelength and causes cell death. A significant proportion of patients with gastrointestinal malignancies cannot undergo curative treatment, as either the cancer is too advanced or the patient's general constitution is too poor to allow invasive strategies. In such cases, PDT has already proven to be a promising therapeutic modality for selected dysplasias and malignancies in the gastrointestinal tract. Material and methods. A retrospective review of the literature was performed in order to determine the experience gained with PDT and to assess its clinical value in the curative and palliative management of gastrointestinal neoplasms. Results. PDT seems to be an adequate treatment for selected forms of early cancer and small lesions of the GI tract or for small residual areas after the tumour has been debulked by other techniques (e. g. limited surgical resection, thermal ablation). Especially for patients who refuse or are ineligible for conventional surgery, PDT offers promising results compared to currently accepted clinical approaches. Conclusions. As a primary or adjuvant mode for either curative or palliative treatment of gastrointestinal neoplasms, PDT is a potentially effective, minimally invasive therapeutic modality. However, further clinical assessment by means of comparative, standardized studies is essential to the definition of its role in oncology.     

Ergebnisse der Resektion zur Ausschaltung nach Finsterer aus klinischer und röntgenologischer Sicht

Zusammenfassung Bericht über die Besonderheiten der hier geübten Operationstechnik bei der Resektion zur Ausschaltung nachFinsterer. Auf Grund der guten Früh-und Spätergebnisse (klinische und röntgenologische Nachuntersuchung von 30 Patienten) wird die R.z.A. bei strenger Indikationsstellung für eine wertvolle Operationsmethode gehalten.Mit 3 Textabbildungen     

Möglichkeiten und Grenzen der Sonographie bei der Kortikotomie-Kallus-Distraktion

Sonographic examination can yield additional information free of radiation in the course of corticotomy/callus distraction. The echogenic structures of the cortical structure and the callus between can be scanned at the area of the callus distraction by ultrasound examination. Individual sectional planes are focussed. They are different from the standardized ultrasound examination. Depending on when the corticotomy was performed, the callus between the cortical structures can be visualized sonographically. First it is echo poor, and then it becomes more and more echogenic. The ultrasound examination can give additional information during the first 4 weeks after corticotomy/callus distraction. A deviation of the axis in the area of callus distraction cannot be judged reliably. A sonographically guided division into three stages is possible.     

Möglichkeiten der Heilverfahrenssteuerung

The German Statutory Accident Insurance (GUV) assumes responsibility for the recovery of health and functioning of insured persons and for their occupational and social integration. To provide the best possible recovery of health and functioning, the GUV can use different strategies to control and manage medical treatment and rehabilitation. After a brief overview of the historical development of the GUV over the last 125 years, possible options for these strategies, particularly for severely injured patients, are presented. Furthermore, this article gives an overview of research on how to optimise medical treatment and rehabilitation and how to implement and manage change. Finally, the article outlines and explains new paths within the GUV for process-oriented quality management using patient-related assessments, which will allow measurement of the quality of various therapies.     

Möglichkeiten der Schlaganfallversorgungsforschung

Background

The implementation of thrombolysis to treat acute ischemic stroke patients in Baden-Württemberg was accompanied by a comprehensive stroke treatment concept with implementation of stroke units in every local district and a stroke registry has been running for many years. The possibilities for stroke healthcare service research using data from the registry are presented and exemplified with two typical analyses.

Method

This article presents a retrospective analysis of a consecutive register containing data from all stroke patients in the federal state of Baden-Württemberg admitted to hospital less than 7 days after stroke onset. Data from the time period 2008–2012 were analyzed.

Results

The exemplified analyses for the time-dependent effect of thrombolysis showed that early thrombolysis is also associated with a better outcome in the clinical routine. The analysis of thrombolysis rates showed substantial differences depending on the treatment level of the stroke unit, especially in patients over 80 years old and with preexisting disabilities.

Conclusion

The presented analyses show the possibilities for neurological health services research by analyzing routine quality assurance data. The stroke care concept of the federal state of Baden-Württemberg not only allows a good comprehensive patient care but due to the special features of regional responsibility, also offers outstanding possibilities for vascular health services research.

     

Möglichkeiten der Heilverfahrenssteuerung

Trauma und Berufskrankheit - Die Träger der Gesetzlichen Unfallversicherung (GUV) haben den normierten Auftrag, die Gesundheit und die Leistungsfähigkeit ihrer Versicherten...     

Potenziale und Möglichkeiten des Fast-track-Konzeptes in der Aortenchirurgie

The retrospective analysis of 103 patients who underwent open aortic surgery and fast track rehabilitation between 10/2007 and 1/2010 revealed high acceptance by the patients and reduction of perioperative complications as well as a reduction of hospital stay. There was no mortality and the fast track-related complication rate was 1.9%. By using an interdisciplinary approach it is possible to establish an aortic fast track rehabilitation program that is able to face the challenges of endovascular aortic surgery.