Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Jun 2013
Clinical Trial[Dorsolateral access and interbody spinal fusion in spondylodiscitis of the thoracolumbar spine (TLIF technique)].
SURGICAL GOAL: Resolve infection and achieve primary stability of instrumentation and permanent fusion of the affected spinal segment by means of debridement of the focus of infection. Defect-filling using autologous/allograft bone or a spacer, as well as immobilization by means of dorsal instrumentation. ⋯ Successful fusion of affected segments, including resolution of infection, is reported in over 90% of cases described in the literature. The revision rate among our mostly multimorbid patient group with an average age of 66 years was 16%. Of 39 of the 114 (34%) patients with preoperative neurological deficits, 26 (66%) demonstrated postoperative regression. Nine patients (23%) showed no improvement, whilst exacerbation of existing neurological deficits was seen in four patients (11%). Staphylococcus was the major pathogen in 34% of cases.
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Oper Orthop Traumatol · Jun 2013
Reinforcement of lumbosacral instrumentation using S1-pedicle screws combined with S2-alar screws.
Increasing construct stability of lumbosacral instrumentations using S2-ala screws as an alternate to iliac screws. ⋯ Retrospective review of 80 patients undergoing S2-ala screw fixation. Main diagnosis was degenerative lumbar instability, adult scoliosis, high-grade listhesis, and nonidiopathic scoliosis. In 66% of patients, the instrumentation using S2-ala screws was part of a major lumbosacral revision surgery. Follow-up averaged 26 months. There were no deaths or major neurovascular complications. First time fusion rate at L5-S1 was greater than 90%. Eight patients (10%) experienced a complication which could be related to the S2-ala screws. Out of 160 S2-ala screws, 16 screws were judged to cause focal irritation and were removed, indicating a survival rate of 90% for the S2-ala screw.
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Replacement of full thickness soft tissue defects in the lower leg and ankle, appropriate to the defect and following the course of blood vessels feeding the skin of a distally hinged fasciocutaneous flap most reliably based on the individual anatomy of distal perforators of the posterior tibial artery. ⋯ Retrospective uncontrolled study with over 70 saphenous perforator flaps from 1995-2011. Full soft tissue defects 62 times with osteomyelitis, 3 times with endoprothesis, 3 times with fractures, 2 times with exposed tendons. From 1995-2006, 44/50 (88 %) flaps healed completely or at least to 3/4 without the necessity of further flaps; from 2007-2011, 13/20 (65 %) flaps healed completely and 6/20 (30 %) flaps healed at least to 3/4 without the necessity of further flaps, loss of one flap (5 %).
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Defect coverage especially in exposed bone of the lower leg by pedicled muscle flaps in association with a split-thickness skin graft. Defect coverage oropharyngeal or at the upper extremity by free soleus flaps. ⋯ Reliable results achieved at the middle and distal lower leg.
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Soft tissue defect reconstruction by transposition of well-vascularized muscle tissue with a muscle flap and as an osteomuscular flap together with a fibular bone segment for combined skeletal and soft tissue defects. ⋯ Reliable, excellent functional and aesthetic results with very low donor site morbidity.