Der Unfallchirurg
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Case Reports
[Marjolin's ulcer: malignant transformation of a crural ulcer due to posttraumatic chronic osteomyelitis].
We report on the case of an 81-year-old female patient who developed a squamous cell carcinoma in a long-lasting therapy-resistant crural ulcer of the lower leg due to posttraumatic chronic osteomyelitis. Eventually the lower leg had to be amputated because of massive destruction of soft tissue and the tibia bone. ⋯ The amputation stump had completely healed 6 months after surgery and the patient is fitted with an artificial limb ensuring independent mobility even outside the home. Up to the present there is no evidence of any tumor recurrence or progression.
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Posttraumatic deformities with need for surgical correction are rare and demanding in the pediatric population. The consequences of a bad outcome may last a life time. The best prevention of deformities around the elbow joint is proper initial treatment. ⋯ In contrast to the wide spread opinion to await the effect of the further growth, the deformity should be treated contemporarily to the underlying injury. This strategy will optimize the outcome. In special cases treatment with delay is justified.
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Casualties in military conflict produce patterns of injuries that are not seen in routine surgical practice at home. In an era of increasing surgical sub-specialization the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. Improvised explosive devices (IEDs) have become the modus operandi for terrorists and in the current global security situation these tactics can be equally employed against civilian targets. ⋯ Log books will be kept in accordance with the training curricula. On successful completion of the program medical officers will be officially appointed as Medical Officer "Einsatzchirurg" by their commanding officers for a maximum of 5 years and it will be necessary to renew it after this period. These refresher programs will require participation in visiting physicians programs in the complementary surgical disciplines in order to retain the essential specific skills.
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Since 1992 the German Bundeswehr has been deployed for securing peace and peacekeeping abroad. Since then 83 German soldiers have been killed and overall 129 wounded in action as of 07.12.2009. In Northern Afghanistan the German Bundeswehr runs a combat support hospital (role 3) in Mazar-e-Sharif providing a multidisciplinary capability profile. ⋯ The German Navy also has two equivalent role 2 medical treatment facilities (Naval Rescue Centers) aboard its two combat support ships (CSS) "Berlin" and "Frankfurt am Main" to support maritime task groups operating worldwide. These floating field hospitals provide an indispensable asset in the medical emergency care of naval operations with difficult space-time factors. Due to the specific operating alliance between CSS and Naval Rescue Center, special operations as well as evacuation and humanitarian missions following disasters near the coastline can be effectively accomplished.