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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Malignant bone tumors are very rare entities in the bones of the hand. The histologic subtypes (chondrosarcoma, osteosarcoma, Ewing-sarcoma) preferentially manifest in varying regions of the skeleton. Chondrosarcomas are the most frequent malignant bone tumor type in the hand. ⋯ A definitive treatment of malignant bone tumors should be carried out in specialized centers, as these tumors are rare. Surgical therapy is completed by chemo- or radiotherapy, if required because of histologic subtype and local or systemic spreading. Safe margins of tumor resection should be preferred to function-preserving treatment for tumors of the hand while the preservation of functional units should be pursued whenever possible.
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Handchir Mikrochir Plast Chir · Apr 2013
Review[Autologous fat grafts and supportive enrichment with adipose tissue stromal cells].
Liposuction is a most common surgical procedure in aesthetic surgery that aims at the local fat reduction. The obtained adipose tissue is currently used as a biocompatible filler. Autologous fat transplantation, also known as lipofilling, has become an attractive treatment method in the field of aesthetic facial surgery and scar tissue reconstruction. ⋯ Thus enrichment of the fat graft with autologous ASC, known as cell-assisted lipotransfer (CAL) may lead to further optimisation of lipofilling concerning fat graft survival. Still aiming to establish the application of autologous fat grafts and ASC in breast reconstruction, there is a necessity for systematic analyses in order to resolve questions regarding the operational technique and qualitative aspects of the ASC manufacturing in accordance with pharmaceutical guidelines and regulations in Germany. Besides, some open questions need to be addressed regarding the ASC differentiation potential in vivo.
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Handchir Mikrochir Plast Chir · Jun 2012
Review[Diagnostic guidelines for complex regional pain syndrome].
The complex regional pain syndrome, a special form of neuropathic pain, develops after a minor trauma of the distal limbs. Besides the presentation of pain disproportional to the inciting event, further plus and minus symptoms in the form of sensory, vasomotor, sudomotor-oedematous and motor-trophic changes can be found. Interindividually and intraindividually, occurrence of these symptoms differs widely and single symptoms can be lacking completely. ⋯ A temperature difference can be detected via infrared thermography. Furthermore, quantitative sensory testing can verify the magnitude of the sensory disturbance and can be beneficial to objectify therapeutic effects. Use of these diagnostic tools, even after achievement of normal findings, cannot exclude a CRPS and the decision for therapeutic initiation should not be influenced thereby.
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State of the art CRPS therapy comprises medication, interventional therapies and non-pharmaceutical treatments like physiotherapy (PT), occupational therapy, PT with cognitive behavioural elements (mirror therapy, 'motor imagery', and 'graded exposure'), psychotherapeutic methods, local therapies and neurostimulation. These treatments are mostly as successful as medical or interventional treatment. ⋯ Adjuvant therapies were shown to reduce pain and the severity of dysfunction in CRPS. Therefore, these non-drug therapies should be an essential part of any multimodal CRPS treatment.
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Handchir Mikrochir Plast Chir · Jun 2012
Review[Lesions of the peripheral nerves: MR neurography as an innovative supplement to electrodiagnostics].
The diagnostic work-up of peripheral neuropathies largely depends on neurophysiological investigations. Recently, progress in magnetic resonance imaging (MRI) has lead to new perspectives in the diagnostics of disorders of the peripheral nervous system (PNS). ⋯ In particular, the localisation of nerve lesions can be improved by MR techniques. Furthermore, MR neurography enables new insights in the pathophysiology of neuropathies which will be shown for diabetic polyneuropathy.