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 · Feb 2013
[Diagnostic value of preopratively performed MRI regarding lesions of the scapholunate ligament in clinical routine].
The purpose of this retrospective study was to examine the sensitivity and specificity of preoperatively performed MRI of the wrist in identifying tears of the scapholunate ligament. Additionally, these findings were then compared with findings from a subsequently performed -arthroscopy of the wrist. ⋯ The comparison of MRI vs. arthroscopic sensitivity and specificity in the detection of scapholunate tears on a sufficiently large group of patients showed MRI to be a reliable method in excluding scapholunate ligament tears. Outside of clinical study conditions, however, it was found to be an unsuitable method in identifying and classifying scapholunate ligament tears. The high MRI sensitivity found by other studies could not be confirmed in our study.
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Handchir Mikrochir Plast Chir · Feb 2013
Hemi-hamate autograft arthroplasty for acute and chronic PIP joint fracture dislocations.
Treatment of fracture dislocations of the PIP joint represents a hand surgical challenge. In hemi-hamate arthroplasty, the palmar joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. ⋯ Hemi-hamate autograft arthroplasty represents an effective procedure to address severe PIP joint fracture dislocations. It restores the comminuted articular surface in chronic injuries and in the acute injury it is a challenging but valuable alternative to extension block splinting. However, donor site morbidity and revision surgery have to be taken into account.
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Handchir Mikrochir Plast Chir · Dec 2012
Lymphaticovenular bypass surgery for lymphedema management in breast cancer patients.
Historically, the reported incidence of upper extremity lymphedema in breast cancer survivors who have undergone axillary lymph node dissection has ranged from 9% to 41%. In the past 2 decades, sentinel lymph node biopsy has become popular as a way to minimize the morbidity associated with axillary dissection without compromising the cure rate for breast cancer patients. However, even with sentinel node biopsy, the postoperative incidence of upper limb lymphedema in breast cancer patients remains at 4-10%. ⋯ Physiologic methods such as flap interposition, lymph node transfers, and lymphatic bypass procedures aim to decrease lymphedema by restoring lymphatic drainage. In contrast, reductive techniques such as direct excision or liposuction aim to remove fibrofatty tissue generated as a consequence of sustained lymphatic fluid stasis. Currently, microsurgical variations of lymphatic bypass, in which excess lymph trapped within the lymphedematous limb is redirected into other lymphatic basins or into the venous circulation, have gained popularity.
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Handchir Mikrochir Plast Chir · Oct 2012
[Development of length of stay and reimbursement in elective hand surgery after the introduction of DRGs in Germany].
Since its introduction in Germany, the DRG (Diagnosis-Related Groups) system is often fraught with negative connotations. Frequent points of criticism are a deterioration of patient care by decreasing length of stay (LOS) in hospital and a decline in reimbursement. The following investigation analyzes and compares the development of length of stay and reimbursement in hand surgery based on the 3 most common elective procedures. ⋯ With declining revenue per case, the average income per day increased by a reduction in hospital days. A positive or at least equivalent revenue situation can thus only be achieved by a distinct concentration of labor and reduction of hospital days under the DRG-system.
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Handchir Mikrochir Plast Chir · Oct 2012
Case Reports[Artificial synostosis for traumatic metacarpal defect: a case report].
Reconstruction of traumatic metacarpal defects is still challenging because of the key function of the architecture of the metacarpus for the function of the entire hand. Especially the exact restoration of the rotation for a parallel finger movement plays an important role. ⋯ We present a 28-year old patient with a traumatic almost complete defect of the fourth metacarpal. Reconstruction of the metacarpal arch was achieved with an artificial synostosis between the intact head of the 4th metacarpal and the 3rd metacarpal.