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 · Jan 1998
[Treatment of fingertip defect injuries with a semi-occlusive dressing].
In the treatment of substance loss of fingertips it is crucial to maintain functional length and to restore adequate sensibility. By treating those injuries with a semiocclusive dressing according to Mennen and Wiese (1993), we were able to achieve both goals with excellent results, avoiding the necessity of local or regional flaps as well as shortening of bone to achieve primary closure. 82 patients with 85 injured digits were treated either conventionally (primary closure with or without shortening of bone, vaseline gauze dressings: 31 digits) or with semiocclusive dressings (54 digits). 42 digits of the latter group with complete protocols were evaluated at the end of treatment. 26 digits with defects of skin and subcutaneous tissue of less than 1 cm2 to more than 2 cm2 necessitated an average of 18 days until complete healing (minimum 6, maximum 46 days). ⋯ No complications, especially no infections have been observed. All healed finger-tips were well padded, painless, many without visible scar and with static two-point discrimination between 2 and 8 mm.
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Handchir Mikrochir Plast Chir · Jan 1998
[Primary shortening--secondary lengthening. A new treatment concept for reconstruction of extensive soft tissue and bone injuries after 3rd degree open fracture and amputation of the lower leg].
The main problem in major limb replantation--especially of the lower extremity--is an extensive bone- and soft-tissue loss. The traditional replantation concept tries to preserve the initial limb length; only a small shortening is accepted. To avoid a more extensive shortening, often insufficient debridement at the time of replantation is carried out. ⋯ Six to twelve months after replantation, secondary limb lengthening is started using an external or internal (= programmable intramedullary nail) distraction device. Since 1985, twelve patients (six macroamputations and six third-degree open fractures of the lower leg) have been treated using the "concept of primary shortening with secondary limb lengthening". Indications, operative technique, and results are shown and discussed, comparing this new concept to the traditional "concept of staged length-reconstruction" with extensive free tissue reconstruction and secondary nerve grafting.