A. Daigeler

Scaphoid nonunions in skeletally immature adolescents

Scaphoid nonunions in children requiring operative treatment are rare. The aim of this study was to analyze our own patient population of the last 13 years to assess the postoperative outcome of these operations. Seven patients, under aged 14 years, were treated for scaphoid nonunions. Patients were clinically and radiologically examined and subjective outcomes were measured, such as the visual analogue pain scale (VAPS), Disability of the Arm, Shoulder and Hand (DASH) score, and Krimmer score. All patients showed an excellent outcome, as determined by the DASH score, Krimmer score, and VAPS. No differences between grip strength and range of motion between the operated and non-operated hand were observed. Therefore, we propose that scaphoid nonunions in skeletally immature adolescents can be treated satisfactorily with excision of the nonunion and bone grafting.

Wundheilungsstörungen bei Rauchern, Nichtrauchern und nach Rauchstopp

BACKGROUND The pulmonary and cardiovascular ramifications of smoking are well documented and this also applies to increased wound healing complications in smokers. The aim of this study was to ascertain whether preoperatively refraining from smoking would affect the incidence of wound healing disorders. MATERIAL AND METHODS Between 2006 and 2008 a total of 295 patients underwent aesthetic (n = 167) or reconstructive surgery (n = 128). They were divided into three groups: A (n = 98) non-smokers for at least 2 years, B (n = 99) patients who refrained from smoking 6 weeks prior to surgery and C (n = 98) smokers. Smoking abstinence was verified by cotinine tests. Wound healing complications were defined as dehiscent wounds, wound infections, atypical scar formation and adiponecrosis. RESULTS Smokers developed wound healing complications in 48.2% of cases, non-smokers in 21.0% and patients who had stopped smoking for 6 weeks in 30.8% of cases (p = 0.006). CONCLUSION Elective surgery should only be performed on non-smokers and smokers who had refrained from smoking for at least 6 weeks to reduce wound healing complications as far as possible.

Remote ischemic Conditioning – endogene Gewebeprotektion und ihre Einsatzmöglichkeiten in der Chirurgie

Tissue perfusion is pivotal to wound healing and tissue regeneration after surgery. Ischemia and reperfusion lead to inflammatory reactions with consecutive tissue damage and necrosis. Multiple conditioning techniques have been described to protect tissue from those damaging mechanisms in the perioperative period. However, most of these fail to meet the requirements of a good therapeutic effect, time and cost efficiency, non-invasiveness and applicability without the need for additional devices or drugs. Remote ischemic conditioning (RIC) is a technique to provide endogenous tissue protection, which fully meets those requirements. Repeated, short cycles of ischemia/reperfusion applied to a circumscribed vascular territory lead to the activation of endogenous signal pathways resulting in increased tolerance to hypoperfusion and limiting the damage caused by reperfusion, even in tissues located far away from the conditioned area. The non-invasive application of the conditioning stimulus requires no more than a pressure cuff, which is placed on the upper arm and is repeatedly inflated to suprasystolic pressures. Different concepts of remote ischemic pre-, peri- and postconditioning enable the usage in both elective and emergency surgical interventions. Based on encouraging experimental studies, the application of RIC has increased in the clinical setting. In addition to studies addressing cardio-, nephro- or neuroprotection there are some initial findings supporting a potential beneficial application in reconstructive microsurgery. This article aims to give an overview of the development, concepts and mechanisms of RIC with a focus on its clinical application in the field of surgery.

Defektdeckungsoptionen nach Eviszeration

Weichteildefekte nach Eviszeration bei onkologischen Eingriffen stellen nach wie vor ein signifikantes Problem dar. Aufgrund der anatomischen und funktionellen Besonderheiten stellt die Rekonstruktion dieser Defekte im Beckenbereich eine Herausforderung dar und erfordert eine differenzierte Vorgehensweise. In diesem Beitrag werden aktuelle Strategien und Optionen der rekonstruktiven Verfahren unter Berucksichtigung praoperativer Gegebenheiten und plastisch-chirurgisch relevanter Faktoren vorgestellt. Auf die Relevanz der interdisziplinaren Zusammenarbeit und den hieraus resultierenden Nutzen wird hingewiesen. Die Einbeziehung des plastischen Chirurgen bereits in die praoperative Planung der Tumorresektion wird empfohlen.

Plastische Rekonstruktionsmöglichkeiten beim chronischen Sinus pilonidalis

INTRODUCTION Chronic pilonidal disease represents an infectious disease of the gluteal cleft that often requires surgical resection. AIM In this article, several plastic-surgical reconstructions are presented. METHODS AND RESULTS Based on our experience and the current literature, different plastic surgical reconstructive methods are presented and discussed. Thorough debridement including sinus tracts and follicles represents an important step in the treatment algorithm. Subsequently, wide defects may remain that can require reconstructive surgery with local flaps. These may include a Karydakis procedure, Limberg transposition flap, V-Y advancement or rotation flap. CONCLUSION After thorough debridement and adherence to plastic surgical principles, sufficient reconstructions can be obtained with the presented methods.Einleitung: Der chronische Sinus pilonidalis ist eine entzundliche Erkrankung der Gesasfalte, welche bei chronischen Verlaufsformen i. d. R. chirurgisch therapiert werden muss. Zielstellung: In dem vorliegenden Artikel werden verschiedene plastisch-chirurgische Verfahren vorgestellt. Methoden und Ergebnisse: Plastisch-chirurgische Verfahren werden anhand eigener Erfahrungswerte und unter Berucksichtigung ausgewahlter Referenzen vorgestellt und diskutiert. Das radikale Debridement unter Entfernung samtlicher Sinus und Haarnester stellt einen entscheidenden Schritt dar. Im Anschluss bestehen haufig Weichteildefekte, welche mit lokalen Lappenplastiken rekonstruiert werden mussen. Hierbei konnen verschiedene Lappenplastiken wie Karydakis-, Limberg-, V–Y- oder Rotationslappenplastiken zum Einsatz kommen. Schlussfolgerung: Bei Beachtung eines adaquaten Debridements und plastisch-chirurgischer Grundprinzipien kann mit den dargestellten Methoden ein suffizienter Weichteilverschluss erreicht werden.

Surgical Treatment of Extravasation Injuries

OBJECTIVE Extravasations account for most iatrogenic injuries. The aim of the study was to analyse the results of surgery in patients with extravasations and to draw conclusions for future treatment. MATERIALS AND METHODS 24 patients with soft-tissue defects after extravasations were treated between 1999 and 2009 in our hospital. The cases were analysed retrospectively. We looked at the drugs causing tissue necrosis and the localisation in relation to the number of interventions and reconstruction complexity. RESULTS In 83 % (n = 20) of cases tissue necrosis was caused by chemotherapeutic agents, in 8 % (n = 2) by contrast mediums and in 4 % (n = 1) by antibiotics and insulin. 70 % of the cases involved the upper extremity, in 30 % the thoracic wall was affected. 38 % of the extravasations occurred over venous access ports. In mean 2 ± 1.5 interventions were necessary for defect coverage. Two patients died as a direct result of the extravasations, one due to sepsis originating from an infected necrosis area and one due to right-heart failure with prior pulmonary damage. CONCLUSION Most extravasations can be treated without surgery. In cases of toxic extravasations or pressure-caused ischaemia rapid surgical intervention is necessary to prevent the necrosis progressing to deeper tissue layers.