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
-
Handchir Mikrochir Plast Chir · Jul 2001
[Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius].
To investigate the occurrence of carpal ligamentous injuries in patients with fractures of the distal radius, the results of 122 wrist arthroscopies were analysed within a retrospective study. Indications for arthroscopy included suspected carpal instability according to radiographic findings and/or the necessity for internal fixation of the radius fracture. Arthroscopy revealed acute scapholunate ligament tears in 84 patients. ⋯ There was no association between ligamentous lesions and carpal angles or fracture dislocation. Scapholunate ligament tears were most frequent in sagittal articular fractures. In these cases, wrist arthroscopy should be performed during operative treatment of the radius fracture to allow direct visualization and subsequent repair of ligamentous tears.
-
Handchir Mikrochir Plast Chir · Mar 2001
Case Reports[Revascularization and defect coverage of the hand: special applications of the radialis forearm flap].
During the last years, a large number of newly designed flaps have been presented, suitable to cover defects of the hand. Some of them, namely the retrograde interossea-posterior and the lateral arm flaps, found their way into daily clinical routine. They even seem to have replaced the standard flaps for defect coverage to the hand, the pedicled groin flap and the radial forearm flap. ⋯ Primary treatment of complex injuries to the hand and forearm often requires revascularization of ischemic parts of the limb and coverage of large soft-tissue defects at the same time. The radial forearm flap, either as a distally pedicled flap or as a free flap, meets all the needs or in particular is appropriate to perform such demanding primary procedures. The destruction of the arterial palmar arches does not present a contraindication against the use of a distally pedicled radial forearm flap, but actually is a strong indication to reconstruct the radial artery by a vein graft.
-
Handchir Mikrochir Plast Chir · Mar 2001
Comparative Study[Value of several examination systems in patients with carpal tunnel syndrome. Comparison of Dellon computer-assisted sensation test with Mellesi hand status and Levine examination scheme].
The goal of the presented carpal tunnel syndrome (CTS) follow-up study was to compare the clinical value of the Millesi hand function score with the "Pressure Specifying Sensory Device" (PSSD) introduced by A. L. Dellon using self-administered patient questionnaires. 25 patients (10 male, 15 female) with an electrodiagnostically confirmed CTS were enrolled in this study, performing one preoperative and five postoperative examinations over 24 weeks. 12 of the 25 patients underwent an "open" two-portal carpal tunnel release with two minimal incisions (group OT); the other 13 patients were treated with a two-portal endoscopic carpal tunnel release (group ET). ⋯ L. Dellon. In the postoperative course of group ET, a distinct worsening in the sensibility of the index and little finger could only be detected with the PSSD before the patients noticed the onset of related symptoms.
-
Handchir Mikrochir Plast Chir · Jan 2001
[Defect coverage of the hand and forearm with a free scapula-parascapula flap].
Complex defects of the forearm and hand are associated with the loss of important structures. Single-stage reconstruction of these defects requires composite tissue transplantations. The subscapular region offers various components for the coverage of complex defects. The scapular and the parascapular flaps can be used each as cutaneous, fasciocutaneous and osteocutaneous or as a combined flap as well. The purpose of this study was to present our experience with the combined scapular-parascapular free flap for defect coverage of the forearm and hand in 13 patients. ⋯ This study demonstrates that the combined scapular-parascapular free flap is a reliable treatment choice for early coverage of defects of the forearm and hand. The advantages are the long, large and consistent vascular pedicle, the possibility of combination with other flaps and "custom-tailoring", including whatever component is necessary to close the particular defect.
-
Handchir Mikrochir Plast Chir · Nov 2000
[Pseudarthroses after distal radius fractures. What is the role of the distal radioulnar joint?].
Non-union following distal radial fracture is extremely rare. Therefore, the patterns are not completely understood. Recently, it was suggested that an associated distal ulna shaft fracture increases the risk to develop a non-union for comminuted fractures of the distal radius. ⋯ From the review of the records of these 15 cases, we recommend that non-union with more than 5 mm of subchondral bone supporting the articular surface distal to the non-union site undergo reconstruction of the radius. Non-union with less than 5 mm subchondral bone supporting the articular surface requires an individual decision. A good bone stock and stable fixation allows for reconstruction of the radius, otherwise wrist fusion is a useful salvage procedure.