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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Carpal tunnel syndrome is the most common compression syndrome of a peripheral nerve. It mostly affects patients older than 50 years. One cause for a carpal tunnel syndrome is transthyretin (ATTR) amyloid, which deposits in the carpal tunnel tissue. Carpal tunnel syndrome can be the first symptom of ATTR amyloidosis, which in the worst case leads to amyloid cardiomyopathy with the symptoms of heart failure with reduction in quality and time of life. For this article, all histological tissue samples of carpal tunnel tissue, collected from 2010 to 2018, were evaluated according to age and gender of each patient. Evaluation of the ATTR amyloid content in different regions of the carpal tunnel has enabled a recommendation for resection for optimal histological diagnosis. ⋯ Both men and women develop a carpal tunnel syndrome caused by ATTR amyloid. In particular, at the age of over 50 years, amyloid deposits should be considered in the context of the etiological clarification of the carpal tunnel syndrome. Early histological diagnosis is highly relevant to identify the risk of cardiac amyloidosis. For an early and correct diagnosis of ATTR amyloidosis, histological examination of the flexor retinaculum is particularly necessary, and a sample excision should always be obtained and examined histologically.
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Handchir Mikrochir Plast Chir · Sep 2018
["Pathway protection" - enhanced motoneuron regeneration by end-to-side coaptation of sensory axons].
Proximal nerve injuries and delayed nerve repair lead to reduced peripheral nerve regeneration. Poor functional results after nerve injury are clinically a very challenging problem. Experimental studies defined "chronic axotomy" of the neuron and the proximal part of a dissected nerve that are separated from their distal target, as well as "chronic denervation" of the distal nerve stump as an independent factors that reduce regenerative capacity of injured nerves. ⋯ In recent years, sensory "pathway protection" was investigated to avoid such motor deficit. Motoneuron regeneration of its axons can, in experimental animal models, be improved by end-to-side coaptation of sensory donor axons to either a denervated distal nerve stump or to a long autologous nerve graft, both of which undergo changes associated with chronic denervation. Sensory "pathway protection" has already been successfully clinically applied, however long-term functional analysis awaits.
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Handchir Mikrochir Plast Chir · Aug 2018
[DRG revenues and costs of multimorbid patients in the German DRG system - Analysis of the surgical treatment of chronic wounds at a university hospital based on the example of pressure ulcers].
The treatment of complex patients with chronic wounds, such as pressure ulcers, is often not adequately reimbursed in patients with need for daily intensive care due to multimorbidity and chronic co-diagnoses. The present study analyses revenues, principle cost factors as well as possible complications. ⋯ The treatment of most multimorbid patients with decubital ulcers is often not adequately reimbursable within the German DRG system. A strict treatment algorithm with a reduced number of operations and intensive patient care are helpful approaches, but may not be sufficient to reduce cost-intensive complications. It seems important to re-evaluate the current DRG codes for these cases.
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Handchir Mikrochir Plast Chir · Jun 2018
[The Malunited Distal Radius Fracture - Extraarticular Correction without Bone Graft].
In open wedge osteotomies of the distal radius, bone grafts increase initial stability and enhance bone formation but are frequently associated with complaints and complications at the donor site. Previous studies have suggested that bone grafting may probably be unnecessary. ⋯ After open wedge osteotomy of the distal radius, remodeling may occur without filling the defect by a bone graft. Since bony healing is not predictable and may require more than 12 months in single cases, we will continue bone grafting in our own practice.
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Handchir Mikrochir Plast Chir · Aug 2017
Clinical Sign for Missed Decompression of a Separate Extensor Pollicis Brevis Compartment in de Quervain's Disease.
Persistent pain despite previous surgery for de Quervain's disease might be due to an overlooked septum between the abductor pollicis longus tendon slips and the extensor pollicis brevis tendon, or an overlooked completely separate compartment for the extensor pollicis brevis tendon alone. In both of these instances, extension of the MP joint of the thumb against resistance elicits pain at the distal level of the first extensor compartment of the wrist. When this sign is positive, revisional surgery and decompression of the remaining septum or separate compartment is indicated.