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 2012
Case Reports[Osteotendocutaneous radial forearm flap for hand reconstruction following circular saw injury].
Circular saw injuries may cause severe damage to the soft tissue of the hand, including destruction of skin, tendons and bone. We report the use of an osteotendocutaneous radial forearm flap for hand reconstruction following circular saw injury. This flap allowed simultaneous reconstruction of skin, tendon and osseous defect of the metacarpal bone.
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Handchir Mikrochir Plast Chir · Jan 2012
Case Reports[Compression of the ulnar nerve at Guyon's canal caused by a pseudoaneurysm of the ulnar artery following trauma].
We repor there on a 16-year-old patient who presented with pain and swelling in the hypothenar eminence as well as loss of sensibility in the fingers of the region innervated by the ulnar nerve; this happened 2-3 weeks after an injury by a glass splinter in his proximal palm. A pseudoaneurysm could be verified by duplex sonography. The patient wished to avoid any graft for arterial bridging for religious reasons. ⋯ The patient recovered perfectly. 4 years later, an MR-angiography showed the deep and superficial transverse palmar arc to be supplied by a voluminous radial artery. The ulnar finger arteries originated from the deep arc, the radial finger arteries from the superficial arc. In this paper, the criteria pro and contra grafting the ulnar atery at Guyons's canal will be discussed.
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Handchir Mikrochir Plast Chir · Dec 2011
Comparative Study[Comparison of pedicle and free tissue transfers in the German DRG system].
Diagnosis-Related Groups (DRGs) are a patient classification system grouping related types of patients to the resources they have consumed. In this analysis, we compared pedicle and free flaps in plastic and reconstructive surgery in the actual German DRG system. After grouping common flaps while systematically modifying the diagnosis, the operative procedure(s), and the receptor site, reimbursement and thresholds of length of stay were identified. ⋯ Higher DRG conformity is generally found with free flaps. Different possibilities in coding the procedures and the strong dependence on the underlying diagnosis lead to variations of remuneration and length of stay, which are not explainable and sometimes even seem paradoxical. Furthermore, mixed calculation creates DRGs that lose the ability to describe the real effort.
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Handchir Mikrochir Plast Chir · Dec 2011
Comparative Study[Viability of autologous fat grafts harvested with the Coleman technique and the tissu trans system (shippert method): a comparative study].
Various methods for harvesting and refining autologous fat grafts have been described. One of the standard procedures, the Coleman technique, is based on manual aspiration to reduce the negative presssure and the centrifugation of the grafts. The Shippert technique uses automatic liposuction with reduced negative pressure and abstains from centifugation in order not to reduce viability of the graft by exposing it to centrifugal forces. ⋯ This is in part due to the condensation of the graft by centrifugation using the Coleman technique. The factor of condensation of the grafts harvested and refined with the Coleman technique exceeds the factor of increased fat graft viability in comparison to the Shippert technique. The Tissu Trans system is more than twice as fast and easier to use with a preferential use for large volume grafts like in breast augmentation, whereas the Coleman technique produces a more condensed graft, favouring it for fat grafting to the face where less volume is needed.
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Handchir Mikrochir Plast Chir · Dec 2011
[Preventing lower limb amputations in patients suffering from diabetic foot syndrome and peripheral vascular disease - opportunities and limitations].
The number of patients suffering from a diabetic foot syndrome is increasing. In many cases large plantar or heel defects can only be reconstructed by using a free flap. The free parascapular flap is an alternative to free muscle flaps in the reconstruction of plantar or heel defects. Donor site morbidity is low. Autologous bypass reconstruction or an angioplasty can increase extremity perfusion. PATIENTS AND OPERATIONS: 52 patients with a diabetic foot syndrome have been reconstructed since 2007. 23 of them required a free tissue transfer. On average these patients were 68.7 years of age. A parascapular flap was used in 15 cases, a latissimus dorsi flap with a skin graft in 4 cases, a gracilis muscle flap with a skin graft in 3 cases. In one case a free instep flap of the contralateral foot, which had to be amputated, was used. In 13 cases the flap was anastomosed to the autologous bypass, in one case an AV loop was used. ⋯ If the correct indication is met, free flaps can prevent diabetes-derived amputations of the lower limb. The parascapular flap can be used for plantar and heel defects. Flap harvesting is quick due to the constant vascular anatomy. The donor site morbidity is low. Reconstruction requires revascularisation in an interdisciplinary setting including vascular surgeons and radiologists. Limb salvage reduces mortality and improves quality of life. Revascularisation and reconstruction should best be done in a single surgical procedure.