K. Knobloch

MRI-Based Breast Volumetry—Evaluation of Three Different Software Solutions

As lipofilling of the female breast is becoming more popular in plastic surgery, the use of MRI to assess breast volume has been employed to control postoperative results. Therefore, we sought to evaluate the accuracy of magnetic resonance imaging (MRI)-based breast volumetry software tools by comparing the measurements of silicone implant augmented breasts with the actual implant volume specified by the manufacturer. MRI-based volume analysis was performed in eight bilaterally augmented patients (46 ± 9xa0years) with three different software programs (Brainlab© I plan 2.6 neuronavigation software; mass analysis, version 5.3, Medis©; and OsiriX© v.3.0.2. 32-bit). The implant volumes analysed by the BrainLab© software had a mean deviation of 2.2 ± 1.7% (ru2009=u20090.99) relative to the implanted prosthesis. OsiriX© software analysis resulted in a mean deviation of 2.8 ± 3.0% (ru2009=u20090.99) and the Medis© software had a mean deviation of 3.1 ± 3.0% (ru2009=u20090.99). Overall, the volumes of all analysed breast implants correlated very well with the real implant volumes. Processing time was 10xa0min per breast with each system and 30xa0s (OsiriX©) to 5xa0min (BrainLab© and Medis©) per silicone implant. MRI-based volumetry is a powerful tool to calculate both native breast and silicone implant volume in situ. All software solutions performed well and the measurements were close to the actual implant sizes. The use of MRI breast volumetry may be helpful in: (1) planning reconstructive and aesthetic surgery of asymmetric breasts, (2) calculating implant size in patients with missing documentation of a previously implanted device and (3) assessing post-operative results objectively.

Differentiation of superficial-partial vs. deep-partial thickness burn injuries in vivo by confocal-laser-scanning microscopy

OBJECTIVEnThe current determination of burn depth is based both on a visual and clinical assessment. Confocal-laser-scanning microscopy (CLSM) enables in vivo histomorphological images. We hypothesized that CLSM can differentiate superficial-partial vs. deep-partial thickness burns on a histomorphological level.nnnMETHODSnThirty-eight burn wounds in 14 patients were clinically divided in three groups from superficial (group 1), superficial-partial (group 2) to deep-partial (group 3) thickness burns. CLSM was performed with the Vivascope 1500 (Lucid Inc., Rochester, NY, USA) 24h after burn. The following parameters were assessed: cell size of the granular-layer, thickness of the basal-layer, minimal thickness of the epidermis and number of perfused dermal papillae.nnnRESULTSnSuperficial burns resulted in a significant increase of the cell size of the granular-layer and a higher increase of the minimal thickness of the epidermis as in superficial-partial thickness burns. The granular-layer in partial thickness burns was destroyed. Superficial burns had an increased thickness of the basal-layer; in superficial-partial thickness burns the basal-layer was partly destroyed with complete destruction in deep-partial thickness burns. In superficial burns the perfused dermal papillae were increased significantly, while decreased in superficial-partial thickness, and completely destroyed in deep-partial thickness burns up to a depth of 350 microm.nnnCONCLUSIONSnIn vivo confocal-laser-scanning microscopy can differentiate superficial-partial vs. deep-partial thickness burns on a histomorphological level.

In vivo evaluation of histomorphological alterations in first-degree burn injuries by means of confocal-laser-scanning microscopy-more than "virtual histology?".

There are various approaches to the treatment of superficial burns. No modality exists to date for determining treatment efficiency on morphological features. We review the first application of high-resolution in vivo confocal-laser-scanning microscopy (CLSM) to the evaluation of superficial burns on a histomorphological level. Sixteen patients (6 women, 10 men; 34.5 ± 16.2 years) with first-degree thermal contact injuries to a maximum extent of 1% of the body surface were enrolled into the study. CLSM was performed with the Vivascope 1500 (Lucid Inc., Rochester, NY) 24 hours after injury. The following parameters were assessed: cell size of the granular layer, thickness of the basal layer, minimal thickness of the epidermis, and diameter of capillary loops. Compared with the control sites 24 hours postburn, the minimal thickness of the epidermis increased on average by approximately 11% (P = .01; t-test); the thickness of the basal layer increased about 7% (P = .008; t-test); the diameter of capillary loops increased approximately by 17% (P = 0.003; t-test); and the cell size of the granular layer increased about 8% (P = .009; Wilcoxon’s test). In vivo CLSM allows characterizing and quantifying histomorphological alterations in superficial burns. CLSM could be helpful in assessing the effects of various treatment approaches for superficial burns on a histomorphological level.

[Nicotine in plastic surgery : a review].

BACKGROUNDnThe surgical complication rate is significantly increased in active smoking patients. However there are no evidence-based recommendations regarding smoking among patients seeking plastic surgical procedures.nnnMETHODSnMEDLINE analysis was performed of all relevant clinical and experimental papers from 1965 to 2008.nnnRESULTSnIn face-lift operations smokers present a 13-fold risk of skin necrosis. In mamma reduction procedures the risk among smokers is doubled for number of complications, with T-incision site necrosis (odds ratio 3.1) and infection rate (OR 3.3) significantly elevated among active smokers. Transverse rectus abdominis myocutaneous flaps for breast reconstruction are associated with significantly higher flap necrosis rates for smokers than nonsmokers (19% vs 9%, P=0.005). The smoking history can be indicative, but usually the number of cigarettes is drastically underestimated. Cotinine testing is a method of determining smoking quantitatively up to 4 days before testing.nnnCONCLUSIONnFour weeks of abstinence from smoking reduces smoking-associated complications. Despite the published evidence, smoking is no longer relevant in the German 2008 Disease-Related Group for plastic surgical procedures.ZusammenfassungHintergrundDie chirurgische Komplikationsrate wird durch aktives Rauchen dramatisch erhöht. Dennoch existieren keine allgemeingültigen Richtlinien zur Durchführung elektiver plastisch-chirurgischer Eingriffe bei aktiven Rauchern.MethodenEs wurde eine Medline-Analyse der publizierten klinischen und experimentellen Arbeiten von 1965 bis 2008 durchgeführt.ErgebnisseBei Faceliftoperationen tragen Raucher ein 13fach erhöhtes Risiko für die Entwicklung von Hautnekrosen gegenüber Nichtrauchern. Bei Mammareduktionsplastiken ist neben der Anzahl der Komplikationen (Odds ratio [OR] 2,1) die Häufigkeit von Nekrosen im Bereich des T-Schnitts (OR 3,1) und die Infektionsrate (OR 3,3) signifikant erhöht. Der Eigengewebeaufbau der Brust mit dem Transverse-rectus-abdominis-myocutaneous-Lappen zeigt bei Raucherinnen eine signifikant höhere Lappennekroserate als bei Nichtraucherinnen (19% vs. 9%, p=0,005). Der Cotinine-Test ermöglicht die quantitative Erfassung eines Nikotinkonsums bis zu 4xa0Tage vor dem Test.SchlussfolgerungVier Wochen Nikotinkarenz kann die raucherassoziierten Komplikationen bei elektiven plastisch-chirurgischen Eingriffen senken. Trotz der bekannten nachteiligen Wirkungen des Rauchens erfolgen plastisch-chirurgische Eingriffe bei aktiven Rauchern. Die Komorbidität durch aktives Rauchen wird allerdings im DRG-System 2008 nicht länger erlössteigernd erfasst.AbstractBackgroundThe surgical complication rate is significantly increased in active smoking patients. However there are no evidence-based recommendations regarding smoking among patients seeking plastic surgical procedures.MethodsMEDLINE analysis was performed of all relevant clinical and experimental papers from 1965 to 2008.ResultsIn face-lift operations smokers present a 13-fold risk of skin necrosis. In mamma reduction procedures the risk among smokers is doubled for number of complications, with T-incision site necrosis (odds ratio 3.1) and infection rate (OR 3.3) significantly elevated among active smokers. Transverse rectus abdominis myocutaneous flaps for breast reconstruction are associated with significantly higher flap necrosis rates for smokers than nonsmokers (19% vs 9%, P=0.005). The smoking history can be indicative, but usually the number of cigarettes is drastically underestimated. Cotinine testing is a method of determining smoking quantitively up to 4xa0days before testing.ConclusionFour weeks of abstinence from smoking reduces smoking-associated complications. Despite the published evidence, smoking is no longer relevant in the German 2008 Disease-Related Group for plastic surgical procedures.

Nikotinkonsum und plastische Chirurgie

BACKGROUNDnThe surgical complication rate is significantly increased in active smoking patients. However there are no evidence-based recommendations regarding smoking among patients seeking plastic surgical procedures.nnnMETHODSnMEDLINE analysis was performed of all relevant clinical and experimental papers from 1965 to 2008.nnnRESULTSnIn face-lift operations smokers present a 13-fold risk of skin necrosis. In mamma reduction procedures the risk among smokers is doubled for number of complications, with T-incision site necrosis (odds ratio 3.1) and infection rate (OR 3.3) significantly elevated among active smokers. Transverse rectus abdominis myocutaneous flaps for breast reconstruction are associated with significantly higher flap necrosis rates for smokers than nonsmokers (19% vs 9%, P=0.005). The smoking history can be indicative, but usually the number of cigarettes is drastically underestimated. Cotinine testing is a method of determining smoking quantitatively up to 4 days before testing.nnnCONCLUSIONnFour weeks of abstinence from smoking reduces smoking-associated complications. Despite the published evidence, smoking is no longer relevant in the German 2008 Disease-Related Group for plastic surgical procedures.ZusammenfassungHintergrundDie chirurgische Komplikationsrate wird durch aktives Rauchen dramatisch erhöht. Dennoch existieren keine allgemeingültigen Richtlinien zur Durchführung elektiver plastisch-chirurgischer Eingriffe bei aktiven Rauchern.MethodenEs wurde eine Medline-Analyse der publizierten klinischen und experimentellen Arbeiten von 1965 bis 2008 durchgeführt.ErgebnisseBei Faceliftoperationen tragen Raucher ein 13fach erhöhtes Risiko für die Entwicklung von Hautnekrosen gegenüber Nichtrauchern. Bei Mammareduktionsplastiken ist neben der Anzahl der Komplikationen (Odds ratio [OR] 2,1) die Häufigkeit von Nekrosen im Bereich des T-Schnitts (OR 3,1) und die Infektionsrate (OR 3,3) signifikant erhöht. Der Eigengewebeaufbau der Brust mit dem Transverse-rectus-abdominis-myocutaneous-Lappen zeigt bei Raucherinnen eine signifikant höhere Lappennekroserate als bei Nichtraucherinnen (19% vs. 9%, p=0,005). Der Cotinine-Test ermöglicht die quantitative Erfassung eines Nikotinkonsums bis zu 4xa0Tage vor dem Test.SchlussfolgerungVier Wochen Nikotinkarenz kann die raucherassoziierten Komplikationen bei elektiven plastisch-chirurgischen Eingriffen senken. Trotz der bekannten nachteiligen Wirkungen des Rauchens erfolgen plastisch-chirurgische Eingriffe bei aktiven Rauchern. Die Komorbidität durch aktives Rauchen wird allerdings im DRG-System 2008 nicht länger erlössteigernd erfasst.AbstractBackgroundThe surgical complication rate is significantly increased in active smoking patients. However there are no evidence-based recommendations regarding smoking among patients seeking plastic surgical procedures.MethodsMEDLINE analysis was performed of all relevant clinical and experimental papers from 1965 to 2008.ResultsIn face-lift operations smokers present a 13-fold risk of skin necrosis. In mamma reduction procedures the risk among smokers is doubled for number of complications, with T-incision site necrosis (odds ratio 3.1) and infection rate (OR 3.3) significantly elevated among active smokers. Transverse rectus abdominis myocutaneous flaps for breast reconstruction are associated with significantly higher flap necrosis rates for smokers than nonsmokers (19% vs 9%, P=0.005). The smoking history can be indicative, but usually the number of cigarettes is drastically underestimated. Cotinine testing is a method of determining smoking quantitively up to 4xa0days before testing.ConclusionFour weeks of abstinence from smoking reduces smoking-associated complications. Despite the published evidence, smoking is no longer relevant in the German 2008 Disease-Related Group for plastic surgical procedures.

Kniegelenkverletzungen des ungeschützten Verkehrsteilnehmers im Straßenverkehr

ZusammenfassungHintergrundZiel dieser Studie war es, die Inzidenz und Art des Zustandekommens von Verletzungen des Kniegelenks bei ungeschützten Verkehrteilnehmern, d.xa0h. von Fußgängern, Motorrad- und Fahrradfahrern, zu untersuchen.Material und MethodenZwei verschiedene Zeitperioden (1985–1993 und 1995–2003) sind auf das Vorliegen von Knieverletzungen (abbreviated injury scale, AISKnie=2 oder 3) hin überprüft worden. Analysiert wurden Verkehrsunfälle mit Personenschäden am Unfallort direkt nach dem Unfall. Von diesen Verletzten konnten unfalltechnische Daten (Anprallart, Geschwindigkeit und Richtung) und klinische Daten (AIS, ISS, Gesamtverletzungsmuster, Einzelverletzungen) analysiert und verglichen werden. 2580 Fußgänger, 2279 Motorradfahrer und 4322 Fahrradfahrer aus 22.794 Verletzten in 17.382 Unfällen wurden für diese Studie herausgefiltert.ErgebnisseSchwere Band- oder knöcherne Verletzungen des Kniegelenks fanden sich bei 2% (96/9181xa0Patienten) in Bezug auf alle verletzten ungeschützten Verkehrsteilnehmer. Das Risiko für Knieverletzungen war für Zweiradfahrer größer als bei den Fußgängern, aber letztere wiesen schwerere Knieverletzungen auf. Das Gesamtrisiko ist im Vergleich niedrig und in der letzten Zeitperiode signifikant reduziert (35>28%, p<0,0001). Das aerodynamische Design der Fahrzeugfronten senkte signifikant (p=0,0015) das Risiko für schwere Knieverletzungen.SchlussfolgerungenAm stärksten gefährdet sind motorisierte Zweiradfahrer gefolgt von Fußgängern. Da die aerodynamische Frontgestaltung aktueller Pkw im Vergleich zum älteren Design bereits Inzidenz und Schwere von Knieverletzungen bei Fußgängern verringern konnte, ist eine weitere Modifikation der Außengestaltung sinnvoll.AbstractBackgroundThe purpose of this study was to assess the risk of knee injuries among vulnerable road users, such as pedestrians, bicyclists and motorcyclists.MethodsTwo different periods (years 1985–1993 and 1995–2003) were compared. Inclusion criteria were furthermore Abbreviated Injury Scale knee 2–3 (AISknee). Technical analysis assessed the type of collision, direction and speed as well as the injury pattern, and different injury scores (AIS, ISS) were examined documented by the accident research unit, which analyses technical and medical data collected shortly after the accident at the scene. This study included 2,580 pedestrians, 2,279 motorcyclists and 4,322 bicyclists from a total number of 22,794 victims in 17,382 accidents.ResultsAmong vulnerable road users, 2% (196/9181 patients) had serious ligamentous or bony injuries of the knee. The risk of injury was higher for motorcyclists and bicyclists than for pedestrians. Knee injury severity was higher for pedestrians. Over the course of 18xa0years, the knee injury risk was significantly reduced in more recent times (35% >28%, p<0.0001). Improved aerodynamic design of car fronts reduced the risk for severe knee injuries significantly (p=0.0015).ConclusionsThe highest risk for knee injuries among vulnerable road users is encountered by motorcyclists followed by bicyclists and pedestrians. Over time, the knee injury risk for pedestrians could be significantly reduced due to aerodynamic changes of current car fronts. Further modification of the exterior car design might decrease the risk for knee injuries among vulnerable road users.

Rhabdomyolysis after administration of diclofenac

ZusammenfassungRhabdomyolysen werden infolge einer Vielzahl traumatischer und nichttraumatischer Ereignisse beobachtet. Pharmakologisch kann die Gabe von Statinen oder auch der Stimulanzienmissbrauch von Methylendioxymethamphetamin (MDMA, „Ecstasy“) zur Rhabdomyolyse mit dem Vollbild des akuten Nierenversagens führen. Wir beschreiben den Fall einer durch Diclofenac induzierten Rhabdomyolyse nach einer Kumulativdosis von 200xa0mg oral und kritischem Anstieg der Kreatinkinase und des Myoglobins. Bei der Verordnung von Diclofenac sollte neben den bekannten Nebenwirkungen auch die Gefahr einer medikamenteninduzierten Rhabdomyolyse bekannt sein. Beim Auftreten von Myalgien sollte umgehend die klinisch-chemische Kontrolle der Kreatinkinase und des Myoglobins erfolgen, um die Gefahr eines akuten Nierenversagens zu reduzieren.AbstractRhabdomyolysis may develop after various traumatic and nontraumatic circumstances. The use of lipid-lowering statins as well as the abuse of stimulants such as methylendioxymethamphetamine (ecstasy) can lead to fatal rhabdomyolysis with acute renal failure. We describe a case of diclofenac-induced rhabdomyolysis after a cumulative dose of 200xa0mg per os with consecutive critical increase of the creatine kinase and myoglobin. Prescription of diclofenac should therefore be done with caution. In cases of emergent myalgias, immediate testing of creatine kinase and myoglobin is mandatory to exclude fatal rhabdomyolysis with acute renal failure.

Habilitationsordnungen medizinischer Fakultäten an deutschen Hochschulen

ZusammenfassungHintergrundDie Anforderungen für eine Habilitation an einer deutschen medizinischen Fakultät sollten im Vergleich zu vor 12xa0Jahren reevaluiert werden. Zugrundeliegende Hypothese ist, dass die Anforderungen an die Habilitation angestiegen sind und dass die Kriterien vereinheitlicht wurden.Material und MethodenEs wurde eine unabhängige Analyse der aktuell 2010xa0gültigen Habilitationsordnungen auf 12xa0Zielparameter und eine Bewertung dieser mittels eines Scoring-Systems im Vergleich zu 1998 (nach Nagelschmidt) durchgeführt.ErgebnisseDer Gesamtscore nach Nagelschmidt für die Habilitationsleistung ist von 15,2±5,1 (95%-Konfidenzintervall 13,6–16,9) im Jahr 1998 auf 21,9±4,0 Punkte im Jahr 2010 gestiegen (95%-Konfidenzintervall 20,6–23,3; p<0,001). Insbesondere die Anforderungen an die Publikationsleistung, an das Vorhandensein eines Facharztes und an die Lehrtätigkeit sind nachhaltig gestiegen. Wir fanden keine Korrelation zwischen der Anzahl der Habilitationen pro Fakultät und dem Habilitationsscore (y=−0,0545x+26,021; r2=0,00028).SchlussfolgerungDie Habilitationsanforderungen stiegen von 1998 auf 2010 signifikant um 44%. Dies basiert auf gestiegenen Anforderungen in Bezug auf die Publikationsleistung, die Lehrtätigkeit und Lehrbefähigung und die Anerkennung als Facharzt. Wir konnten keinen Zusammenhang zwischen der Anzahl der Habilitationen pro Fakultät und dem Gesamtscore pro Fakultät nachweisen. Schließlich konnten wir eine Vereinheitlichung der Anforderungen an die medizinischen Habilitanden deutschlandweit an medizinischen Fakultäten im Vergleich zu 1998 feststellen.AbstractBackgroundIn Germany, Austria and Switzerland the „Habilitation“ (postgraduate qualification) is currently the highest ranked university degree which qualifies candidates to perform high ranking autonomous research and teach the specific subject at university level. Although it is legally not an academic degree, the habilitation is a mandatory qualification for the later appointment and employment as a professor. The habilitation process is a complex assessment of diverse prerequisites which differ highly in terms of uniformity among the medical faculties in Germany.MethodsIn order to re-evaluate these prerequisites and to find out if there might be more conformity for candidates all habilitation requirements were analyzed for 12 primary outcome measures according to Nagelschmidt and rated with a specific scoring system (Nagelschmidt score).ResultsThe overall scoring for habilitation requirements increased from 15.2±5.1 points in 1998 to 21.9±4.0 points in 2010 (95% confidence interval 20.6–23.3, p<0.001, mainly due to increased requirements in terms of publications, teaching and mandatory board certification. No correlation was found between the number of habilitation degrees per faculty and the overall Nagelschmidt score (y=−0.0545x+26.021, r2=0,00028).ConclusionThe requirements for habilitation have substantially increased by 44% from 1998 to 2010 in Germany. This is mainly based on higher requirements in terms of publications, teaching and board certification.BACKGROUNDnIn Germany, Austria and Switzerland the Habilitation (postgraduate qualification) is currently the highest ranked university degree which qualifies candidates to perform high ranking autonomous research and teach the specific subject at university level. Although it is legally not an academic degree, the habilitation is a mandatory qualification for the later appointment and employment as a professor. The habilitation process is a complex assessment of diverse prerequisites which differ highly in terms of uniformity among the medical faculties in Germany.nnnMETHODSnIn order to re-evaluate these prerequisites and to find out if there might be more conformity for candidates all habilitation requirements were analyzed for 12 primary outcome measures according to Nagelschmidt and rated with a specific scoring system (Nagelschmidt score).nnnRESULTSnThe overall scoring for habilitation requirements increased from 15.2±5.1 points in 1998 to 21.9±4.0 points in 2010 (95% confidence interval 20.6-23.3, p<0.001, mainly due to increased requirements in terms of publications, teaching and mandatory board certification. No correlation was found between the number of habilitation degrees per faculty and the overall Nagelschmidt score (y=-0.0545x+26.021, r(2)=0,00028).nnnCONCLUSIONnThe requirements for habilitation have substantially increased by 44% from 1998 to 2010 in Germany. This is mainly based on higher requirements in terms of publications, teaching and board certification.

Nervale und muskuläre Ersatzoperationen zur Wiederherstellung der gelähmten Ellenbogenfunktion

Paralysis of elbow flexion or extension leads to major impairment of upper extremity function. Surgical reconstruction can be achieved using several procedures. If the time interval since the nerve injury is short, anatomic reconstruction by means of nerve suture or nerve transplantation should be attempted. Alternatively, nerve transposition is possible. If more than 12-18 months have elapsed, reinnervation of arm muscles can no longer be expected. In this case, muscle transposition is helpful. Restoring flexion is predominantly required following brachial plexus injury, when the function of the biceps, brachioradialis and brachialis muscles are lost. As donor muscles the latissimus dorsi, pectoralis major and triceps brachii can be used, alternatively a transfer of the flexor-pronator muscles of the forearm is possible. Latissimus dorsi transfer to reconstruct elbow flexion is also indicated in defects of the anterior upper arm muscle compartiment due to trauma, ischemia, or tumor. Patients with proximal radial nerve lesions may benefit from latissimus transfer to reachieve elbow flexion extension. In tetraplegic patients, elbow extension is restored mainly by transfer of the posterior deltoid muscle extended with a tendon graft, or by means of a biceps-to-triceps transfer.ZusammenfassungDie Lähmung der Beuge- oder Streckfunktion des Ellenbogens beeinträchtigt die Funktion der gesamten oberen Extremität in hohem Maße. Zur chirurgischen Rekonstruktion stehen verschiedene Verfahren zur Verfügung.Liegt eine periphere Nervenschädigung erst kurze Zeit zurück, sollte eine anatomische Rekonstruktion mittels Nervennaht oder Nerventransplantation versucht werden. Alternativ ist eine Nerventransposition möglich. Nach mehr als 12–18 Monaten ist eine Reinnervation der gelähmten Muskeln nicht mehr zu erwarten. Dann können motorische Ersatzoperationen mit Muskeltranspositionen hilfreich sein. Eine Rekonstruktion der Flexion ist vorwiegend nach Plexusschäden erforderlich, bei denen die Mm.xa0biceps brachii, brachioradialis sowie brachialis verloren gehen. Als Ersatzmotoren stehen die Mm.xa0latissimus dorsi, pectoralis major und triceps brachii zur Verfügung. Daneben ist eine Proximalisierung der Unterarmbeuger- und -pronatorenmuskeln (Steindler-Operation) möglich. Die Indikation zur Verlagerung der M.xa0latissimus dorsi zur Ellenbogenbeugung besteht vor allem bei Defekten des vorderen Muskelkompartiments. Bei proximaler N.-radialis-Läsion eignet sich die Latissimustransposition auch zur Wiederherstellung der Ellenbogenstreckung.Bei Patienten mit Tetraplegie wird die Ellenbogenstreckung meist mittels des um ein Sehnentransplantat verlängerten hinteren Anteils des M.xa0deltoideus oder durch eine Bizeps-pro-Trizeps-Umlagerung rekonstruiert.AbstractParalysis of elbow flexion or extension leads to major impairment of upper extremity function. Surgical reconstruction can be achieved using several procedures.If the time interval since the nerve injury is short, anatomic reconstruction by means of nerve suture or nerve transplantation should be attempted. Alternatively, nerve transposition is possible. If more than 12–18 months have elapsed, reinnervation of arm muscles can no longer be expected. In this case, muscle transposition is helpful. Restoring flexion is predominantly required following brachial plexus injury, when the function of the biceps, brachioradialis and brachialis muscles are lost. As donor muscles the latissimus dorsi, pectoralis major and triceps brachii can be used, alternatively a transfer of the flexor-pronator muscles of the forearm is possible. Latissimus dorsi transfer to reconstruct elbow flexion is also indicated in defects of the anterior upper arm muscle compartiment due to trauma, ischemia, or tumor. Patients with proximal radial nerve lesions may benefit from latissimus transfer to reachieve elbow flexion extension.In tetraplegic patients, elbow extension is restored mainly by transfer of the posterior deltoid muscle extended with a tendon graft, or by means of a biceps-to-triceps transfer.

Rhabdomyolyse nach Diclofenacgabe

ZusammenfassungRhabdomyolysen werden infolge einer Vielzahl traumatischer und nichttraumatischer Ereignisse beobachtet. Pharmakologisch kann die Gabe von Statinen oder auch der Stimulanzienmissbrauch von Methylendioxymethamphetamin (MDMA, „Ecstasy“) zur Rhabdomyolyse mit dem Vollbild des akuten Nierenversagens führen. Wir beschreiben den Fall einer durch Diclofenac induzierten Rhabdomyolyse nach einer Kumulativdosis von 200xa0mg oral und kritischem Anstieg der Kreatinkinase und des Myoglobins. Bei der Verordnung von Diclofenac sollte neben den bekannten Nebenwirkungen auch die Gefahr einer medikamenteninduzierten Rhabdomyolyse bekannt sein. Beim Auftreten von Myalgien sollte umgehend die klinisch-chemische Kontrolle der Kreatinkinase und des Myoglobins erfolgen, um die Gefahr eines akuten Nierenversagens zu reduzieren.AbstractRhabdomyolysis may develop after various traumatic and nontraumatic circumstances. The use of lipid-lowering statins as well as the abuse of stimulants such as methylendioxymethamphetamine (ecstasy) can lead to fatal rhabdomyolysis with acute renal failure. We describe a case of diclofenac-induced rhabdomyolysis after a cumulative dose of 200xa0mg per os with consecutive critical increase of the creatine kinase and myoglobin. Prescription of diclofenac should therefore be done with caution. In cases of emergent myalgias, immediate testing of creatine kinase and myoglobin is mandatory to exclude fatal rhabdomyolysis with acute renal failure.