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 · Dec 2007
[Soft-tissue defects on the dorsum of the hand by extravasation of the cytostatic agents: surgical options of treatment].
Systemic treatment with chemotherapeutic agents is often applied by infusions over peripheral vein cannulae located on the hands and lower arms. Dislocation of the cannulae or vein perforation causes an extravasation of the cytostatic agent. This complication occurs in approximately 0.1 - 6 % of intravenous treatments and is rarely noticed before administration of greater volumes. ⋯ After radical debridement no primary closure of the resulting defect was advisable in the first operation. In all cases we could later perform a stable wound closure. In our opinion, this two-step procedure with primary radical debridement, temporary wound coverage and later wound closure should be performed regularly.
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Handchir Mikrochir Plast Chir · Oct 2007
Case Reports[Clinical experiences using the Versajet system in burns: indications and applications].
Early debridement and early skin grafting are the "Gold standard" in the surgical treatment of burns. There are different debridement methods available. ⋯ Especially for debridement of difficult to treat areas - face, neck, lips, fingers, interdigital spaces, convex and concave areas the Versajet System shows its benefits. With the Versajet System, tissue excision is precise; moreover it helps to avoid the damage of viable tissue and its vascular supply.
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Debridement describes the removal of devitalised tissue and debris (to reduce the toxic and bacterial burden) from a wound. In thermally injured tissue, the adoption of excisional strategies has been shown to improve both morbidity as well as mortality, albeit at the expense of creating new donor wounds. Tangential debridement is performed with surgical steel (i.e., Humby or Goulian knife). Other modalities like enzymatic ointments and hydrosurgical systems have shown promise in refining the debridement process, affording a measure of control with respect to the depth of debridement.
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Handchir Mikrochir Plast Chir · Oct 2007
[New strategies for the treatment of thermally injured hands with regard to the epithelial substitute Suprathel].
The treatment of thermally injured hands has changed in the last 20 years. An early necrectomy and grafting with split-skin grafts is recommended by most burn specialists. The outcome in regard to cosmetic and functional results could be improved by early grafting. ⋯ Suprathel was applied primarily in 78 hands (71.6 %). 3 hands were treated otherwise. 8 of the hands which were primarily treated by Suprathel (10.3 %) required a well-aimed grafting after one or two weeks, 70 (89.7 %) had a complete epithelisation without grafting. Many skin grafts could be avoided. We modified our strategy for the treatment of burned hands by our excellent experiences with Suprathel.
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Handchir Mikrochir Plast Chir · Oct 2007
Case Reports[Use of V.A.C. Therapy in the surgical treatment of severe burns: the Viennese concept].
General principle in the treatment of severe burns is early wound closure. A good take of split-thickness-skin-grafts is essential for fast wound healing and thereby for the outcome of the patient. The aim of the study was to evaluate the impact of V.A.C. therapy in the field of acute burn surgery. ⋯ In our opinion, split-thickness skin-fixation by using V.A.C. therapy is suitable for moist and irregular wound surfaces, for areas exposed to movements and especially for the treatment of older patients with co-morbidities.