Der Unfallchirurg
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The major goal in the treatment of metacarpal fractures is to restore the normal function of the hand. Radiological criteria and the clinical extent of displacement should be individually considered when taking the decision for or against conservative treatment. ⋯ In instable and displaced fractures of the base of the first metacarpal, surgery is regularly performed to restore the bony shape and articular surface. To prevent functional impairments, early mobilization is desirable both during conservative treatment and following internal fixation.
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The stage-adjusted therapy of thermal injuries is based on pathophysiologic mechanisms as well as functional and aesthetic requirements. Plastic reconstructive surgical approaches are highly important in the prevention of the frequent grave sequelae of thermal trauma and to achieve optimal functional rehabilitation and favourable outcome. ⋯ The achievement of early wound closure to preserve functional skin and soft tissue components is an essential part of acute reconstructive procedures. Functional reconstructive and aesthetic procedures supplement the conservative treatment modalities of the secondary phase of burn care with physical therapy, ergotherapy and psychological support.
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Although burn injuries of the hand only account for approximately 2.5-3% of the total body surface area (TBSA), they are of great importance due to functional outcome, appearance and economic aspects. Initial treatment and diagnosis are important factors, which influence the further course of thermal injuries of the hand and which are found in up to 80% of treated burn injuries. Early decision-making is necessary if escharotomy or skin grafting is indicated. ⋯ In the case of full thickness thermal injuries, debridement and skin grafting should be carried out. Further interdisciplinary management involves different professional groups as surgeons and physical therapists. Fitting pressure garments and treatment of scar formation are integral parts of the successful rehabilitation of hand burns.
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Patients with extensive deep partial or full thickness burns require early excision of necrotic tissue, however, in many of these cases simultaneous autografting is not possible due to the general condition of the patient. In this instance temporary dressings like allogeneic or xenogeneic skin or foam dressings can be applied to minimize fluid and protein loss. In Europe glycerolized preserved allogeneic skin remains the treatment standard. ⋯ Reduced contracture rates and increased pliability have been reported after additional dermal enhancement with either collagen-glycosaminoglycan matrix, acellular allogeneic dermis or collagen/elastin matrix. True regeneration of the dermis has not yet been observed. However, these materials are suitable for improvement of the wound bed and also the final result after split thickness skin transplantation.