Der Folien-Vakuumverband zur Behandlung infizierter Hautdefekte

Zusammenfassung Mit Hilfe einer aufgeklebten Plastikfolie und einer Redon-Saugdrainage kann das sich im Bereich osteomyelitischer Hautdefekte ansammelnde Sekret dauernd abgesaugt werden. Dadurch wird die Ausbildung von Granulationen begünstigt, welche schlie?lich eine plastische Deckung des Defekts mit Spalthaut erlauben.

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Summary Putrid secretion accumulating in osteomyelitic skin defects may be continously evacuated by suction drainage at which the defect is covered by a plastic foil. With time granulation takes place. At last skin grafting with Thiersch or Reverdin flaps will be successful.

     

Der ilioinguinale Zugang bei Azetabulumfrakturen

Objective Exposure of the entire anterior column of the acetabulum and of the inner part of the posterior column. Indications Open reduction and internal fixation of fractures of the anterior wall and anterior column of the acetabulum and of fractures, which involve both columns, on the condition that the posterior column can be reduced indirectly. Contraindications Fractures of the posterior wall.Fractures of the posterior column.Factures which involve both columns where the posterior column has to be reduced directly.Fractures requiring a direct access to the acetabulum, e. g., with intraarticular fragments. Surgical Technique Exposure of the acetabular fracture through three surgical windows. First window situated between the iliopsoas and the iliac crest, second window between the inguinal vessels and the iliopsoas, third window betwen the spermatic cord and the inguinal vessels. Indirect reduction of the fracture. Orientation through anatomic landmarks and image intensifier. Fixation of fracture with lag screws (iliac crest) and a long curved plate placed on the iliopectineal line. Results In a 9-year period, 61 patients with acetabular fractures were treated with a stabilization through an ilioinguinal approach. 27 fractures were classified as “simple” and 34 as “combined”. Intraoperative complications related to the approach were four (6.6%) secondary motoric neurologic damages, one thrombosis of the external iliac artery, and a thrombosis of the iliac veins. One fourth of the patients had paresthesias in the area of the lateral femoral cutaneous nerve. Of 38 patients examined after an average of 23 months, 85.4% obtained an excellent or good result using Merle d'Aubigné &; Postel score.     

Beitrag zur Behandlung von Spastikern

Zusammenfassung Zur Übungsbehandlung der Spastiker werden neben den alten Methoden Partnerübungen an geeigneten Apparaturen empfohlen, an denen der Spastiker die autonomen Bewegungsvorgänge in gesunden peripheren Nerven-Muskel-Gebilden möglichst ausnützen soll.Herrn Professor Dr. G. Hohmann zum 80. Geburtstag gewidmet.     

Indikationen zur konservativen Behandlung von Wirbelfrakturen

A realistic comparison of the results of conservative and of operative treatment is hardly possible at present, since the data in the literature have not been classified according to any uniformly adopted system, no prospective comparative studies are reported, a great many different treatment methods have been used, suitable instruments were not available for quantification of study results, and late results are available only in isolated cases. According to the AO fracture classification, compression fractures of types A1 and A2 are definite indications for conservative procedures. In the case of a highly unstable multifragmentary fracture (A2.3) an operative procedure can become necessary. Burst fractures (A3) and more unstable injuries must be surgically treated from the first. Vertebral augmentation is now available as a middle way between conservative and operative treatment. It is indicated in the case of painful osteoporotic or osteolytic compression fractures in the thoracic or lumbar spine originating from primary or secondary osteoporosis or from osteolytic metastases. In contrast to vertebropasty, kyphoplasty offers the possibility of fracture realignment as well as the definite pain relief it affords.     

Therapeutische Optionen zur Behandlung von Fersendefekten

INTRODUCTION: The treatment of soft tissue defects of the foot and ankle region remains a challenge, because special anatomical and physiological properties have to be considered. PATIENTS AND METHODS: The data of 52 patients, who were treated between 1994 and 1998, were analyzed. 48% were posttraumatic defects and were located in the weight bearing zone in 37%. RESULTS: Fifty-nine procedures were used, including skin transplantation in 16 patients, local flaps in 3 cases, regional flaps in 14 cases, and microvascular procedures in 17 cases. Amputation was required in 4 patients. The overall success rate was 92%. Complications occurred in 18 patients. CONCLUSIONS: Using these data and evaluation of the actual literature lead to the development of an algorithm for the treatment of defects in this area. The modern armamentarium of plastic surgery offers the possible different treatment modalities.     

Der Okklusionsverband zur Behandlung von Allen III und IV Fingerkuppenverletzungen als Alternative zu lokalen Lappenplastiken

Background

Fingertip injuries are very common in emergency departments. According to the literature, Allen III and IV fingertip injuries should be treated with local skin flaps. Instead, we have treated these kinds of injuries in recent years with a semi-occlusive dressing. The main purpose of this study was to evaluate the outcome after semi-occlusive dressing therapy with respect to soft tissue cover, recovery of sensibility and duration of disability.

Methods

We retrospectively analysed 77 fingertip injuries (39 Allen I, 25 Allen II, 9 Allen III, 4 Allen IV) from 2008–2011 in 23 women and 54 men who were treated with a semi-occlusive dressing. The mean age was 36 ± 14 years and the mean follow-up was seven months. The bone was not shortened even if the bone was exposed up to the wound level. The primarily occlusive dressing was left as long as possible and was sealed when necessary. Furthermore, the treatment time with the semi-occlusive dressing and the period of disability was recorded. Patient sensitivity recovery was also analysed.

Results

The mean treatment duration was 21 ± 10 days and the mean duration of disability was 30 ± 17 days. The mean duration of disability was 19 ± 8 days for Allen I injuries, 36 ± 16 days for Allen II, 45 ± 20 days for Allen III and 58 ± 7 days for Allen IV. All patients developed satisfactory tissue cover and sensibility recovery. For amputation injuries of Allen III and IV, we recorded a normal light-touch 2?point discrimination in the Semmes-Weinstein Test in 77?% and diminished in 23?%. There were no complications like tissue infections, neuroma or osteitis. Also, no secondary flap supply was necessary.

Conclusions

The semi-occlusive dressing is a good therapy for all kind of fingertip injuries, regardless of the amputation level. Even if the bone is exposed up to the wound level, satisfactory soft tissue cover can be achieved.

     

Indikationen zur konservativen Behandlung von Wirbelfrakturen

Trauma und Berufskrankheit - Der realistische Vergleich der Ergebnisse nach konservativer bzw. operativer Behandlung von Wirbelfrakturen ist kaum möglich, da in den Literaturdaten nicht...     

Aktuelle Überlegungen zur Behandlung von OSG-Frakturen

In the case of ankle fractures, the object of treatment is precise restoration of the biomechanics of the joint. Accurate anatomical repositioning and stable fixation of the bony injuries are regarded as the cornerstones of the operative treatment. Since the work published by Lauge-Hansen we have had a more comprehensive understanding of the total extent of this injury. It must be confessed that this simple and practical classification system is seldom referred to when treatment is being planned during the preoperative phase. Since the advent of core spin and computed tomography, few workers have invested any effort in scientific testing of the results of Lauge-Hansen's empirical work. In addition, the relationships between arthrosis and bony (mal)union and (defective) healing of ligaments following fractures remain unknown to date and must be systematically analyzed.     

Sakroplastie zur Behandlung von Insuffizienzfrakturen des Sakrums

Zusammenfassung Insuffizienzfrakturen des Sakrums sind eine wenig bekannte und daher oft übersehene Verletzung des höheren Lebensalters, welche zu erheblichen und invalidisierenden Schmerzen führen kann.Zur Behandlung schmerzhafter osteoporotischer Frakturen von Wirbelkörpern hat sich inzwischen die perkutane Vertebroplastie mit Polymethylmethacrylat (PMMA) als eine mit geringem Aufwand durchzuführende und gute Ergebnisse zeigende Therapie etabliert. Diese bekannte Technik der PMMA-Injektion lässt sich auch für die Behandlung der Insuffizienzfrakturen des Sakrums anwenden, für die es bislang keine überzeugende Therapie gab.Diese Sakroplastie genannte Technik wurde erstmals 2002 als Fallbeispiel veröffentlicht, 6 weitere Fälle bei dieser Indikation sind inzwischen in der angloamerikanischen Literatur veröffentlicht worden. Dieser Artikel stellt die erste Beschreibung dieser Technik anhand zweier typischer Fälle in der deutschsprachigen Literatur dar und geht insbesondere auf die Schwierigkeiten der Diagnostik, der operativen Technik und mögliche Komplikationen ein. Die beiden Patientinnen wurden erfolgreich behandelt und die Schmerzen besserten sich dramatisch innerhalb weniger Stunden.     

Nanostrukturiertes synthetisches Knochenersatzmaterial zur Behandlung von Knochendefekten

Trauma und Berufskrankheit - Bei der Versorgung von Knochendefektbrüchen ist bis heute die autologe Spongiosaplastik der Goldstandard zum Defektaufbau. In der Literatur werden...     

Diamond-Konzept zur Behandlung von Pseudarthrosen und Knochendefekten

Die Unfallchirurgie - Pseudarthrosen stellen ein sehr heterogenes, seltenes und mitunter sehr komplexes Krankheitsbild dar. Die Ursachen, die Lokalisation und der Grad der Ausprägung zeigen...     

Kallusdistraktion und Segmenttransport zur Behandlung von Knochendefekten

Background

The method of “callus distraction” is the only technique which spontaneously produces vascularized bone within the surrounding soft tissues during lengthening reconstructive procedures. Remodeling of the regenerate bone to specific mechanical load can be influenced by the surgeon. In principle, there is no limit to the amount of new bone formation which can be created; this vascularized bone is both resistant to infection and can be created to replace resected infected bone. This is an important prerequisite for the successful treatment of large bone defects.

Technique

The ring fixator is still a standard tool if no radiological control is available in the operating theater, or in other less sophisticated environments. Over the last 30 years, however, the development of motorized, external and fully implantable systems has made it possible to achieve a significant increase in device implementation, which goes far beyond the standard.

Results

High-performance, reliable, custom-made external and fully implantable systems are cost intensive and require special surgical skills, which can only be ensured at specialized centers. However, the complication-free treatment results justify the effort both for the patient and, ultimately, for the cost bearers.

     

Komplikationen nach osteosynthetischer Versorgung von Azetabulumfrakturen

The early work of Judet and Letournel in the 1970s and 1980s led to a paradigm shift in the treatment of acetabular fractures. The previously purely conservative treatment was replaced more and more by open surgical approaches. The complex, three-dimensional bony anatomy and the periacetabular soft tissue with a close topographic relationship to intrapelvic and extrapelvic neurovascular and visceral structures implicate an increased rate as well as a high risk for intraoperative and postoperative complications. Simultaneously, anatomical reconstruction with a gap step-off less than 1–2 mm is required. Fractures of the acetabulum are comparatively rare and only few trauma centers have the capability and the infrastructure to treat acetabular fractures. Therefore, the aim of this review was to illustrate the possible intraoperative and postoperative complications of osteosynthetic treatment of acetabular fractures as well as to identify possible strategies for treatment and prevention.     

Der V-Y-Lappen zur Versorgung von Fingerkuppendefekten

OBJECTIVE: Restoration of the fingertip with a neurovascular V-Y flap. INDICATIONS: Transverse or oblique defects of the fingertip, also with exposed bone of the distal phalanx. CONTRAINDICATIONS: Larger defects of the phalanx over the proximal interphalangeal joint. Crush injury of the finger. Preexisting lesions of the fingertip. Circulatory disorder. Contamination. Infection of the finger. SURGICAL TECHNIQUE: A single volar (Tranquilli-Leali, Atasoy) or a bilateral V-Y flap (Geissend?rfer, Kutler) is used for restoration of the fingertip. The incision is V-shaped and will be converted to a Y, as the flap is advanced. The subcutaneous tissue of the flap contains neurovascular structures, and provides sensibility and padding of the fingertip. A distal advancement of the flap up to 10 mm is possible with this technique. POSTOPERATIVE MANAGEMENT: Immobilization in a two-finger splint for 1 week. RESULTS: Good functional results.     

Kriterien zur Behandlung von Oberschenkelschaftfrakturen im Kindesalter

Overgrowth and rotational deformity of the injured leg are sequelae of femoral shaft fractures in children. It is still questioned whether the posttraumatic rotational deformity is corrected spontaneously and whether this leads to arthrosis. An individual follow up of 25 children out of 94 with a malrotation after conservatively treated femoral shaft fracture-two to three times up to 4 years after the accident-showed a spontaneous correction of malrotation in 15 (60%). No prearthrotic sign could be found by physical and roentgenographical examination. In accordance with recent publications these results demonstrate again that in children up to the age of ten operative treatment of isolated femoral shaft fracture is not indicated, as posttraumatic malrotation is corrected at least to almost physiological values and no extensive study exist so far, which give evidence that malrotation after femoral fracture in children leads to arthrosis.