Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Replantation in reconstructive surgery is an established procedure due to microsurgical techniques. It can be routinely performed in unilateral lower leg amputation. In some cases of bilateral amputation, in which orthotopic replantation is not possible due to the complex trauma, heterotopic replantation is a therapeutic option. This avoids prosthetic fitting. ⋯ We conclude that, in lower leg amputation, attempts should be made to replant the extremity. In bilateral lower leg amputations, at least one limb should be reconstructed, even if "only" a heterotopic replantation can be performed.
-
Comparative Study
[Proximal humeral fracture in the elderly. Primary head replacement as one alternative].
The treatment of humeral fractures in old patients is still an orthopedic problem. Different surgical schools suggest different treatments for head-preserving procedures. ⋯ Correctly, besides range of movement, the number of necessary reoperations, length of time until pain reduction, and earliest possible axial weight-bearing of the injured limb should influence the therapeutic decision. Regarding all these topics, primary hemiarthroplasty in old patients and specific fracture situations is still to be recommended.
-
We intended to analyze the influence of postoperative delirium on postoperative morbidity and length of hospital stay. ⋯ Patients who developed postoperative delirium have significantly more complications and increased postoperative length of stay in hospital and intensive care units.
-
Comparative Study
[Organization of pain therapy in surgery--comparison of acute pain service and alternative concepts].
An acute pain service done by surgeons is one possibility for organizing pain therapy in surgical wards. To do this successfully, some preconditions must be kept in mind, such as 24-h presence, an integrated system of documentation, and teamwork between medical and nursing staff. Comparison of differently structured pain therapy in three different hospitals (with and without acute pain service) showed high levels of patient satisfaction with the pain therapies in all three hospitals. One of the preconditions for effective pain therapy in surgery is to formulate a concept which takes into account the specific situation of each hospital.