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 · Aug 2007
Comment[Development and implementation of the guideline "Diagnosis of and Therapy for Carpal Tunnel Syndrome"].
In the period from July 2005 through November 2006, the evidence-based guidelines were developed by a steering committee consisting of three members from each of the societies involved (German Society for Hand Surgery, German Society of Neurosurgery, German Society of Neurology and German Society of Orthopaedics), coordinated by one member each from the DGH and the DGNC, under the methodological guidance of Prof. Selbmann of the German Association of the Scientific Medical Societies (AWMF). ⋯ Degrees of recommendation, based upon the degree of evidence of the underlying literature studies, modified, if necessary, by the expert opinion of the steering committee's members and the external evaluators of the Delphi round, were established for the most important diagnostic and therapeutic methods. In addition to the long version, a short version and a patient information bulletin were prepared as well, and the ways, means, and considerations surrounding their realisation and implementation, and other potential developments were also pursued.
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Handchir Mikrochir Plast Chir · Aug 2007
Case Reports Comparative Study[Reintervention after endoscopic surgery of the carpal tunnel syndrome].
The carpal tunnel syndrome is one of the most frequent peripheric nerve compression syndromes. Almost 15 years ago, the endoscopic surgery of the carpal tunnel was introduced, in order to reduce postoperative pain and to shorten the length of the postoperative inactivity period, especially work absence. In the literature the rate of complications due to the endoscopic carpal tunnel release surgery is reported differently in respect to number and severity. This paper summarizes all reinterventions after endoscopic surgery in a single specialized hand surgery department, which prefers the open approach even for first time interventions. ⋯ In 22 cases the result of the endoscopic release of the carpal tunnel forced to redo the intervention. In seven patients there were important lesions of the neurovascular structures. Since the long-term result of the endoscopic and open surgery of the carpal tunnel is comparable, it should be discussed if endoscopic surgery is justified even with the risk of mutilant complications and which preoperative imaging procedure is required to discover pathologies and anatomical variants.
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To point out detailed technical considerations and tactical modifications within the experience of 59 replantations of thumb avulsion injuries, to clarify the indications of replantation, and to evaluate the long-term results. ⋯ In replantation of avulsion amputation of the thumb, functional success depends on repair or reconstruction of all damaged tissues, if necessary, using nerve transfers and tendon transfers. If these could be done primarily as a one-stage reconstruction, the costs would be less, the patients would return to their work when the one-stage treatment and rehabilitation is finished, and would also eliminate the technical difficulties encountered in secondary reconstructions.