Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen
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Handchir Mikrochir Plast Chir · Apr 2012
[Microscope-integrated intraoperative indocyanine green angiography in plastic surgery].
The knowledge of tissue perfusion has not only a prognostic value in microvascular surgery but also the intraoperative detection of malperfusion can lead to a quick surgical intervention. Indocyanine green (ICG) angiography allows a topographic analysis of perfusion and is used to assess lymphatic drainage pathways and to analyse the depth of burn injuries. Integrating the technique into an operating microscope enables visualisation of the flow over microanastomoses and allows the assessment of the transit time of blood flow between arterial and venous anastomosis. ⋯ Particularly for intraoperative assessment, ICG angiography is a useful, reliable and safe technique. The integration into the operating microscope allows an "angiographic patency test" and the analysis of the transit time allows the evaluation of blood flow within the flap. Especially when planning perforator flaps the method of ICG angiography provides a new level of safety in flap design by quickly demonstrating the borders of perfusion.
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Handchir Mikrochir Plast Chir · Jan 2012
[Clinical and radiological results after operative treatment of mallet fracture using Kirschner wire technique].
In our clinic dorsal distal phalanx fractures involving more than 30% of the articulare line in the lateral view are treated operatively using the Kirschner wire technique. Recently conservative treatment of these fractures is more and more recommended. Therefore we investigated in a retrospective study our patients with special regards to complications. ⋯ Because of unsatisfactory results in 63% (n=20), conservative treatment will be our treatment of choice in the future. Operative treatment will only be done in patients with subluxation of the distal phalanx.
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Handchir Mikrochir Plast Chir · Jan 2012
[Results after osteosynthesis of extraarticular proximal phalangeal fractures].
The aim of the study was to retrospectively present and analyse the functional results of surgically treated extraarticular fractures of the proximal phalanx. From 1/2005-4/2008 we operated on 49 patients with 52 closed, extraarticular fractures of the proximal phalanx of the long fingers with either pins, screws or plates. 30 patients were male, 19 were female, the mean age was 35 years. Open fractures, fractures of the thumb and those with injuries to neurovascular structures or tendons were excluded. ⋯ The remaining 11 patients showed a good outcome with a TAM between 220° and 239°. These favourable results remained subjectively stable at the end of the observation period, when all patients could be contacted by phone. Osteosynthesis by kirschner wires, screws and plates for closed extraarticular fractures of the proximal phalanx of the long fingers gives good to excellent results with few complications.
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Handchir Mikrochir Plast Chir · Jan 2012
Case Reports[Osteotendocutaneous radial forearm flap for hand reconstruction following circular saw injury].
Circular saw injuries may cause severe damage to the soft tissue of the hand, including destruction of skin, tendons and bone. We report the use of an osteotendocutaneous radial forearm flap for hand reconstruction following circular saw injury. This flap allowed simultaneous reconstruction of skin, tendon and osseous defect of the metacarpal bone.
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Handchir Mikrochir Plast Chir · Jan 2012
Case Reports[Compression of the ulnar nerve at Guyon's canal caused by a pseudoaneurysm of the ulnar artery following trauma].
We repor there on a 16-year-old patient who presented with pain and swelling in the hypothenar eminence as well as loss of sensibility in the fingers of the region innervated by the ulnar nerve; this happened 2-3 weeks after an injury by a glass splinter in his proximal palm. A pseudoaneurysm could be verified by duplex sonography. The patient wished to avoid any graft for arterial bridging for religious reasons. ⋯ The patient recovered perfectly. 4 years later, an MR-angiography showed the deep and superficial transverse palmar arc to be supplied by a voluminous radial artery. The ulnar finger arteries originated from the deep arc, the radial finger arteries from the superficial arc. In this paper, the criteria pro and contra grafting the ulnar atery at Guyons's canal will be discussed.