Simultaneous multiple flaps in head and neck surgery (author's transl)]

We have developed several variations of the "bilobed flap" for the reconstruction of large defects of the head and neck. In so doing, we use pedicled bi- and tri-lobed flaps, transposition-rotation skin flaps or double-rotation skin flaps. Some examples are described to illustrate the technique employed.     

Bemerkungen zur Trachealchirurgie

Summary During the last 9 years we gained experiences with reconstruction of the trachea in about 135 cases of tracheal stenosis with following methods: Open (most cases), often in the modification with the method of Rethi, sleeve resection, Schobel rings, or the method described by Kornmesser. The average time of treatment was 12 months.Therefore we developed the one stage reconstruction with an island flap, pedicled upon the long muscles of the larynx. With this method, which we have been using since 3 years we were able to reduce the time of treatment to 12 weeks with excellent results. We got normal widths of the trachea and normal resistances.

---

---

Erscheint ausführlich in: Arch. Otorhinolaryngol.     

Comparison of 2 endoscopic surgery techniques for reliable therapy of Zenker diverticulum

BACKGROUND: A mediastinitis or intraoperative bleeding are the most feared complications of the transoral laser assisted diverticulotomy of Zenker's diverticulum. To reduce these complications we developed a new endoscopic surgical technique and compared the results of this new method with the results of patients who we treated earlier. PATIENTS AND METHODS: At the department of Otorhinolaryngology, Head and Neck Surgery, University of Luebeck 68 patients suffering from a hypopharyngeal diverticulum have been treated since 1987. In 64 patients we performed an endoscopic diverticulotomy using a CO2-Laser and the Weerda distending diverticuloscope. Four of the Zenker's diverticulua had to be removed by an external approach. From 1987 to 1994 a five millimeter bar between pouch and hypopharynx after diverticulotomy was left and sealed with fibrin glue in the first 38 patients. From 1995 to 1999 the spur of the hypopharyngeal pouch of the other 26 patients was completely separated. Afterwards we sutured the mucosa between the pouch and the hypopharynx to close the opened mediastinal space and sealed the former spur with fibrin glue. RESULTS: Comparing both endoscopic methods we had to observe concerning our first method one mediastinitis, a rise of body temperature in 29 patients (76%) and we had to perform a revision diverticulotomy in three patients (8%). Our modified technique didn't cause any mediastinitis, a rise of body temperature did only occur in five patients (18%) and no patient had to undergo revision surgery. CONCLUSIONS: The transoral complete separation of the spur of the hypopharyngeal pouch with suturing the mucosa of the pouch and the hypopharynx causes good functional results and means a further reduction of complications and a further improvement of the endoscopic diverticulotomy. Our new instruments (Fa. K. Storz, Tuttlingen) will be demonstrated.     

Mikrochirurgische Eingriffe mit einem neuen Laryngoskop. Ein Beitrag zur Injektionsbeatmung

Summary A new laryngoscope was constructed in order to improve visualization of the larynx and to adjust the instrument to individual situation. The Kleinsasser laryngoscope was divided into two parts. The width between these two halfs can be changed by screws.Because the laryngoscope is open laterally there is more space for the operator and shorter instruments can be used.     

A trilobed rotation cheek flap for closure of facial defects (author's transl)

Rotation flaps of the cheek as described by Imre and by Esser are well known. In some situations we use a "tri-lobed cheek flap" to close defects of the cheek, external nose or temple. This flap is described.