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 1997
Case Reports[Restoration of grip function in both hands after frostbite of all fingers and toes. A case report].
Evaluation, therapeutical possibilities, and surgical planning for the restoration of bilateral grip function are described, based upon a 34-year-old engineer presenting after severe bilateral frostbite of the hands and feet with loss of all fingers and toes. Finally, the given level of amputation and remaining components of the hand together with distraction-lengthening of both thumbs permitted restoring a basic grip on both sides in combination with bone and soft tissue procedures.
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Tenolysis of flexor tendons was performed in 48 fingers of 36 patients. After a mean follow-up to ten months, the total active movement (TAM) was improved from 79 degrees preoperative to 189 degrees postoperative in 84% of the fingers with a minimal improvement of 40 degrees. Following the classification of Buck-Gramcko, 80% (38) of the fingers showed an excellent, good, or fair result. ⋯ These results showed that there is a decrease in improvement when severity of trauma increases. Arthrolysis of PIP-joint showed no negative influence on the results. We are not able to establish a predictive score for flexor tenolysis from our results.
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Handchir Mikrochir Plast Chir · Jul 1996
[Time limited immunosuppression in allogenic nerve transplant in the rat].
A rejection response of peripheral nerve allografts eliminates the Schwann cells without destroying the tubular architecture and leads to a regeneration of inferior quality. Under immunosuppression this rejection is prevented, and allogenic Schwann cells persist in the grafts, leading to a better regeneration result. In adult rats of the strains DA and LEW.1W, a 2,5 cm segment of the sciatic nerve was grafted. ⋯ Best regeneration was observed in the autologous control; no statistical differences were observed between the two experimental groups. Gradual reduction of immunosuppression did not result in an atraumatic replacement of donor derived Schwann cells by recipient derived ones. Allogenic nerve grafting needs continuous immunosuppression, which to date precludes it from clinical application.
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Handchir Mikrochir Plast Chir · Jan 1996
Case ReportsPalmar dislocation in the metacarpophalangeal joint of the thumb--a case report.
A 19-year-old male sustained forced hyperflexion of his right thumb in a motorcycle accident which resulted in a palmar dislocation of the metacarpophalangeal joint. Open reduction was performed which confirmed the rupture of the palmar plate. Dislocation recurred post-operatively. ⋯ Postoperative joint movement was within an acceptable range. However, radiographic examination revealed persistent subluxation. This result was thought to be related to the shape of the head of the first metacarpal bone.
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Handchir Mikrochir Plast Chir · Nov 1995
[The value of technetium scintigraphy for early diagnosis and therapy of severe frostbite].
Frostbites often present with a discrepancy between skin lesions and damage to deeper structures. 14 patients with the diagnosis of severe frostbite and/or hypothermia had been treated between 1990 and 1993. In addition to our standard approach including history, physical exam, and Doppler/Laser-Doppler studies, we performed technecium 99 scintigraphies in seven patients at three to five days after injury. In six patients (86%), there was an excellent correlation between scintigraphic and intraoperative findings. We conclude that early diagnosis and treatment of avital tissue reduces length of hospital stay and allows for maximum amputation stump length preservation.