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 2004
Case Reports Comparative Study[Surgery of post-traumatic brachial plexus lesions (personal approach in 2003)].
The surgery of traumatic brachial plexus lesions has developed extensively. At present (in the year 2003), five different approaches are utilised: A simple nerve transfer to restore elbow flexion without exploration of the brachial plexus is still recommended. In contrast to this technique, in many centres an extensive exploration of the brachial plexus is performed, to clarify an exact anatomical diagnosis. ⋯ In elected cases, a C7 transfer might be indicated in a second stage. Surgery on the brachial plexus is followed by a period of intensive physiotherapy. When the result of the surgery on the brachial plexus can be evaluated, all possibilities of reconstructive surgery have to be applied to maximise the result.
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Handchir Mikrochir Plast Chir · Feb 2004
[Clinical experiences and dosage pattern in subcutaneous single-injection digital block technique].
100 patients with injuries to their fingers were treated using the subcutaneous digital block as described by Low et al.. Different dosages ranging from 2 to 3 millilitres of a local anesthetic were required to obtain appropriate anesthesia according to the location of injury. 108 finger injuries were treated, 18 thumb injuries, 90 finger injuries. The anesthetic was administered using a 0.55 x 25 mm needle and injected strictly subcutaneously into the flexor crease at the base of the finger or thumb. ⋯ Additionally, we performed a deep local nerve block (Oberst), if the patient still felt discomfort or pain. The severity or type of injury did not play a role according to our findings. The subcutaneous finger block as described by Low et al., therefore, is the method of choice treating injuries to the fingers and to the palmar aspect of the thumb, since it offers a decrease in the amount of anesthetic required and increases patient comfort.
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Handchir Mikrochir Plast Chir · Dec 2003
Comparative Study[The Mantero technique for flexor tendon repair - an alternative?].
Regaining free tendon gliding after reconstruction of flexor tendons is essential to restore full function to the affected finger. Mantero et al. described a pull-out suture technique for the repair of flexor digitorum profundus (FDP) lesions in zone 1, allowing early postoperative active mobilisation and thus minimizing the risk of tendon adhesions. In a retrospective study we examined the results after Mantero tendon repair and compared these with the results after different reconstructive procedures in the literature. ⋯ Based on our results, we consider the Mantero technique to be a good alternative to other forms of flexor tendon reconstruction in zone 1 and distal zone 2. Advantages include the possibility of immediate postoperative mobilisation and placing a secure tendon suture, even if the distal tendon stump is very short.
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Handchir Mikrochir Plast Chir · Dec 2003
Comparative Study[Reconstruction of the extensor pollicis longus tendon by transposition of the extensor indicis tendon].
Rupture of the extensor pollicis longus-tendon (EPL) is a frequent complication after distal radius fractures. Other traumatic and non-traumatic reasons for this tendon lesion are known, including a theory about a disorder in the blood supply to the tendon itself. We examined 40 patients after reconstruction of the EPL-tendon in a mean follow-up time of 30 months. ⋯ Generally, the loss of the extension of the index finger is negligible. It does not disturb the patients. But it has to be discussed with the patient before the operation.
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Handchir Mikrochir Plast Chir · Dec 2003
Comparative Study[Results after staged reconstruction of the flexor pollicis longus tendon].
The objective of this study was to evaluate results after staged reconstruction of the flexor pollicis longus tendon (FPL) and to compare the results with literature. The advantages and disadvantages of staged reconstruction with a total duration of therapy of four months are discussed and theoretically compared with the simple and fast alternative, the arthrodesis of the interphalangeal joint (IP) of the thumb. The results of 22 patients from 1993 until 2000, 16 of which could be re-examined, are presented. ⋯ The results show a sufficient function in 75 % of the cases (scoring system of Buck-Gramcko et al.), which is paralleled by a median of 11 in the DASH score. The study shows that staged reconstruction can produce satisfactory results even in thumbs. The results are influenced negatively by persistent flexion contractures, insufficiency of annular pulleys and ailments after algodystrophy, which can be seen as indicator of the severity of the initial injury.