Zentralblatt für Chirurgie
-
In the reconstruction of lacerated flexor tendons excellent and good results could be achieved in 51%.--The best results were obtained in zone 1, 3, 4 and 7 according to Verdan's classification. Depending on the operative technique of reconstruction the best results were obtained in reinsertion and primary suture of the tendons. In free tendon grafting the two-staged procedure gave better results than the modified Paneva-Holewich-technique and this was better than the classical tendon grafting in one operation.--Dissected flexor tendons are recommended to be reconstructed primarily according to Kleinert's principles. Some special operative techniques, suture materials, and new instruments are discussed.
-
The diagnosis of life threatening situations due to blunt chest trauma, the priority of treatment, and therapeutical consequences are discussed. Rib fractures, pulmonary contusions could be treated conservatively. ⋯ Rupture or perforation of the oesophagus, traumatic aneurysms of the thoracic aorta, large diaphragmatic herniations, and penetrating thoraco-abdominal wounds demand an early thoracotomy. Indications for late thoracotomy are: clotted haemothorax and diaphragmatic herniations primarily not diagnosed.
-
Recently 11 cases of severe haemolysis after correction of septal defects have been reported. Our experience with this complication is shown in 5 patients. Conservative treatment as a matter of experience is possible only in a few cases. We use autologous pericardium, Rygg-Perikard resp. to prevent this complication.
-
Case Reports
[Early thoracotomy and chest wall stabilization with elastic rib clamps (author's transl)].
In patients with chest injuries, serial rib fractures and intrathoracic lacerations the indication for primary thoracotomy is usually limited to life-threatening organ ruptures. In our own experience with 18 patients primary thoracotomy offers the chance of immediate closure of lung lacerations, suture of pleural and pericardial tears, ligature of torn intercostal vessels and stabilization of the chest wall by elastic rib clamps "Essener Model". Postoperative respiration, freedom of pain, is restored immediately and therefore complications and duration of high-risk respirator treatment can be reduced.