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1.
Hand (N Y) ; 18(4): 628-634, 2023 06.
Article in English | MEDLINE | ID: mdl-34963321

ABSTRACT

BACKGROUND: Multiple techniques for the repair of flexor tendon injuries in zone 1 have been proposed over time. While pull-out suture techniques and bone anchor seem to be stronger than internal suture techniques, they are associated with a higher complication rate. We therefore developed an alternative internal suture repair with similar biomechanical stability to those of pull-out sutures and bone anchors. METHODS: Twenty porcine distal phalanges and deep flexor tendons were randomized to 2 groups of 10 each. The tendons were transsected at the level of the distal interphalangeal joint. In group 1, repairs were performed with a well-established intraosseous suture repair and in group 2 with our new multistrand technique. The repairs were biomechanically tested with linear distraction until failure. RESULTS: We recorded a significantly higher 2-mm gap force (2GF)-and thus higher stability-of the repairs in group 1 in comparison to group 2. With a 2GF of more than 50 N, our suture technique allows for a modern early active motion rehabilitation protocol. Breakage of the suture construct occurred at random places in the repair in both groups. No pull-outs were noted. CONCLUSIONS: This study presents a strong transosseous multistrand repair technique for flexor tendon repair in zone 1 that is simple and fast to perform and should have enough strength to withstand early active motion rehabilitation.


Subject(s)
Finger Injuries , Tendon Injuries , Animals , Biomechanical Phenomena , Finger Injuries/surgery , Swine , Tendon Injuries/surgery , Tendons/surgery , Tensile Strength
2.
Handchir Mikrochir Plast Chir ; 54(6): 489-494, 2022 Nov.
Article in German | MEDLINE | ID: mdl-36343629

ABSTRACT

Breast implant illness (BII) is a loosely defined term for a collection of non-specific systemic symptoms that are hypothesised to be associated with breast implants. BII symptoms include fatigue, hair loss, rashes, chronic pain, and others. However, conclusive evidence for a causal relationship between silicone implants and BII remains lacking. In the light of recent findings that textured implants can, in rare cases, lead to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a potential link between breast implants and BII is conceivable and justifies further investigation. We observe a growing number of patients seeking consultation and treatment for systemic symptoms related to breast implants, which is reflected in increasing interest in literature and social media. The aim of this work was to investigate the growing interest in BII. We now describe the clinical features of a patient who suffers from symptoms that are consistent with BII and contextualise clinical presentation in a review of literature and google trend analysis.


Subject(s)
Breast Implantation , Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Humans , Female , Breast Implants/adverse effects , Breast Implantation/adverse effects , Lymphoma, Large-Cell, Anaplastic/diagnosis , Lymphoma, Large-Cell, Anaplastic/etiology , Breast Neoplasms/surgery
3.
Praxis (Bern 1994) ; 111(11): 632-638, 2022 Aug.
Article in German | MEDLINE | ID: mdl-35975409

ABSTRACT

Please Don't Forget the Neurogenic Thoracic Outlet Syndrome Abstract. We report the case of a 52-year-old patient who was treated for years for headaches, pain in the neck and arms, and sweating. Despite various therapeutic approaches there was no improvement in the symptoms. Further investigations showed a bilateral thoracic outlet syndrome in the status after multiple bilateral rib fractures after a fall from a window at the age of 18. After the operation of a bilateral thoracic outlet syndrome, the headache disappeared almost completely and there was no more sweating.


Subject(s)
Thoracic Outlet Syndrome , Arm , Humans , Middle Aged , Thoracic Outlet Syndrome/diagnosis , Thoracic Outlet Syndrome/surgery , Treatment Outcome
4.
Eur Radiol ; 31(12): 9446-9458, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34100996

ABSTRACT

OBJECTIVES: The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique. METHODS: Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of '0', '5' and '10' reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of '8' or higher for 80% or more of the panellists. RESULTS: Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available. CONCLUSIONS: Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability. KEY POINTS: • Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.


Subject(s)
Joint Instability , Wrist Injuries , Arthrography , Consensus , Humans , Joint Instability/diagnostic imaging , Ligaments, Articular/diagnostic imaging , Wrist Injuries/diagnostic imaging , Wrist Joint
5.
Handchir Mikrochir Plast Chir ; 53(3): 245-258, 2021 Jun.
Article in German | MEDLINE | ID: mdl-34134157

ABSTRACT

Infections of the distal phalanx are the most common of all hand infections. There are dorsal localised infections, which develop in the area of the nail and are called paronychia, and palmar infections, which affect the fingertip and are the typical felons. The acute paronychia must be specifically opened depending on the site of infection. This requires precise anatomical knowledge of nail structure. Chronic paronychia usually have other causes and treatment is much more difficult. Felons are often extremely painful. There is a complex system of fibrous septa and swelling is limited. If the septa are destroyed a spread into the bones or the flexor tendon sheath is possible.


Subject(s)
Paronychia , Abscess , Fingers/surgery , Hand , Humans , Paronychia/diagnosis , Paronychia/surgery , Tendons
6.
Handchir Mikrochir Plast Chir ; 53(3): 259-266, 2021 Jun.
Article in German | MEDLINE | ID: mdl-34134158

ABSTRACT

The infections of the terminal phalanx are always special. Diseases, tumors or virus infections can look very similar and can show similar symptoms. Many require a radiological, dermatological, histological or general physical clarification, some need no surgery and in some surgery is contraindicated. If surgery is necessary, the exact incision is particularly important. A surgical approach set only a few millimeters wrong, can have catastrophic consequences at the fingertip. Differential diagnoses and the consequences of wrong incisions are shown.


Subject(s)
Paronychia , Surgical Wound , Abscess , Fingers , Humans , Paronychia/diagnosis , Radiography
7.
Handchir Mikrochir Plast Chir ; 53(3): 267-275, 2021 Jun.
Article in German | MEDLINE | ID: mdl-34134159

ABSTRACT

Pyogenic flexor tenosynovitis (PFT) is still the most serious infections of the hand. If the typical cardinal signs of PFT according to Kanavel exist, the indication for surgery should be made immediately. The consequential damage of a delayed surgery with enormous restrictions on the movement of the fingers due to the destruction of the sliding layers and massive adhesions are so serious that conservative therapy attempts are very difficult to justify. The results of Hand therapy after delayed surgery are often disappointing. The rapid surgical intervention and the early opening and relief as well as the irrigation of the tendon sheath can end the disease, the destruction of the sliding layers and the severe pain almost immediately. Quick recognition and quick action are important. With early intervention, normal hand function can often be completely restored.


Subject(s)
Tenosynovitis , Fingers/surgery , Hand/surgery , Humans , Tenosynovitis/diagnosis , Tenosynovitis/surgery
8.
Oper Orthop Traumatol ; 33(3): 183-199, 2021 Jun.
Article in German | MEDLINE | ID: mdl-34106290

ABSTRACT

OBJECTIVE: Creation of a pain-free, flexible and stable (pseudo) joint between the carpus and the base of the 1st metacarpal bone. INDICATIONS: Painful carpometacarpal (CMC)­I joint due to primary or secondary osteoarthritis, CMC­I instability. CONTRAINDICATIONS: Carpal instability, local infection, tumors. SURGICAL TECHNIQUE: Resection of the trapezium (and of the arthritic joint surfaces in CMC­I and STT [scaphoid-trapezium-trapezoid-joint]), stabilization of the base of the 1st metacarpal bone by suspension with a distally pedicled strip of the flexor carpi radialis tendon or variants thereof. POSTOPERATIVE MANAGEMENT: Immobilization in a splint for 3-5 weeks, followed by hand therapy. RESULTS: Worldwide for almost 40 years, regardless of the exact technique, almost always (90%) significant pain reduction, increased strength in the grip and slightly less in the pinch grip, very good mobility, 85-95% very satisfied patients and very good long-term results.


Subject(s)
Carpometacarpal Joints , Trapezium Bone , Arthroplasty , Carpometacarpal Joints/diagnostic imaging , Carpometacarpal Joints/surgery , Humans , Ligaments , Tendons/surgery , Thumb/surgery , Trapezium Bone/diagnostic imaging , Trapezium Bone/surgery , Treatment Outcome
9.
Plast Reconstr Surg Glob Open ; 9(3): e3450, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33907654

ABSTRACT

Soft tissue defect reconstruction at joint regions is a challenging problem due to the sparse excessive tissue and late complication of constrigent scar formation. Priorly irradiated tissue, often the case in sarcoma patients, is especially problematic. The keystone design perforator island flap is safe and reliable. We now present a new keystone flap design, which is particularly suitable for the reconstruction of large soft tissue defects at joint regions. It provides a cutaneous component without the need for a skin graft and therefore minimizes the risk of contracture. Donor site morbidity is negligible. Furthermore, it offers a favorable aesthetic result compared to other flaps, eg, a muscular flap. We propose a new keystone flap design as an extension of Behan's classification, the Keystone flap type IIIb.

10.
Unfallchirurg ; 124(4): 275-286, 2021 Apr.
Article in German | MEDLINE | ID: mdl-33725157

ABSTRACT

Due to the exposed situation of the extension side of the metacarpophalangeal joint when the fingers are bent, injuries in this region are not uncommon. The extensor apparatus lies directly below the skin and the various parts can be easily injured. Due to the complex anatomical structure, the different clinical appearances and the various forms of treatment, injuries of the extensor tendons in the region of the metacarpophalangeal joint must be examined in a very differentiated manner. The not uncommonly occurring deviation phenomenon makes all injuries in zone V suspicious and special attention must be paid to them. The alarming multitude of revision surgeries with tenolysis, arthrolysis and restoration of the balance of extensor tendons or centering show that these operations are much more demanding than the way they are appreciated in the literature and by many surgeons (beginner's operation). The article presents the surgical treatment with suture techniques and reconstruction possibilities as well as the aftercare, in addition to the special anatomy and diagnostics.


Subject(s)
Finger Injuries , Tendon Injuries , Finger Injuries/diagnosis , Finger Injuries/surgery , Fingers , Humans , Metacarpophalangeal Joint/diagnostic imaging , Metacarpophalangeal Joint/surgery , Tendon Injuries/diagnostic imaging , Tendon Injuries/surgery , Tendons
12.
Unfallchirurg ; 123(2): 114-125, 2020 Feb.
Article in German | MEDLINE | ID: mdl-31822942

ABSTRACT

The secondary reconstruction of flexor tendons is in most cases very demanding and tedious. The indications, selection of the correct surgical procedure, operative technique and further treatment have to be individually adjusted and are mostly very difficult. Due to the previous operations unpleasant surprises may occur intraoperatively, which must be recognized and treated by the surgeon. Nevertheless, a significant improvement of the function of the whole hand can be achieved for most patients, e.g. by a two-stage flexor tendon transplantation or other techniques described in this article.


Subject(s)
Finger Injuries , Hand Injuries , Orthopedic Procedures , Tendon Injuries , Finger Injuries/surgery , Hand , Hand Injuries/surgery , Humans , Tendon Injuries/surgery
14.
JRSM Open ; 6(6): 2054270415593718, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26266041

ABSTRACT

Human orf should be considered based on a typical presentation with erythematous papule/nodule to avoid unnecessary over-treatment.

16.
Plast Reconstr Surg ; 116(1): 153-8, 2005 Jul.
Article in English | MEDLINE | ID: mdl-15988262

ABSTRACT

BACKGROUND: Distal intraarticular radius fractures can be operated on by means of a palmar or dorsal approach. The dorsal approach has been reported as a treatment option that often leads to tendon ruptures. The purpose of this study was to show that a dorsal implant does not lead to a high rate of tendon ruptures. METHODS: A retrospective study was conducted in which the patient population was analyzed for complaints and complications, follow-up time, and further surgical procedures. RESULTS: A series of 389 patients with distal intraarticular fractures of the radius treated with the dorsal Pi Plate is reported. There was a complication rate of 6.7 percent within the first 2 postoperative months. A special focus was on the occurrence of extensor tendon ruptures, which occurred in five cases in the patient population. This most feared complication occurred within the first 8 months after surgery and in no case at a later stage. All tendon ruptures were reconstructed and healed without further complications. Hardware was removed in 75.5 percent of patients after 6 to 8 months. In the remaining 24.5 percent of patients, the plates were left in situ for more than 33 months, and 89 percent of these patients were free of pain and had excellent movement in the wrist. CONCLUSIONS: The authors conclude that the Pi Plate is a very good surgical option, especially in complicated, comminuted fractures classified as C3. It is not associated with an overly high risk of extensor tendon ruptures, as has been suggested by other authors.


Subject(s)
Fracture Fixation, Internal/adverse effects , Fractures, Comminuted/surgery , Prostheses and Implants , Radius Fractures/surgery , Female , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/methods , Humans , Male , Middle Aged , Prosthesis Design , Retrospective Studies , Rupture , Steel , Tendon Injuries , Tendons/surgery
17.
Plast Reconstr Surg ; 114(6): 1622-30, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15509961

ABSTRACT

The literature on short scar mastopexy was reviewed, with a focus on the different techniques. Currently four techniques have been described: the periareolar, the vertical, the inverted-T, and the L-shaped scar. The different techniques were evaluated with regard to patient selection, operative techniques, scar length, and complications. A large number of techniques have been published for minimal ptosis, whereas for significant ptosis, the number of surgical options is limited. It is evident that limited scar techniques can be applied to all grades of ptosis, but there is no one technique that can satisfactorily correct all degrees of ptosis. Plastic surgeons should weigh the advantages and limitations of each technique to correctly address breast ptosis. This article reviews an algorithmic approach to correct all degrees of ptosis with mastopexy.


Subject(s)
Breast/surgery , Cicatrix/prevention & control , Mammaplasty/methods , Postoperative Complications/prevention & control , Esthetics , Female , Humans , Nipples/surgery , Suture Techniques
18.
Arch Orthop Trauma Surg ; 124(8): 563-7, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15340747

ABSTRACT

BACKGROUND: Tumoral calcinosis occurs in two distinct clinical forms. The sporadic form is secondary to chronic renal failure, hyperparathyroidism, milky-alkali syndrome, hypervitaminosis D and other systemic disorders. The familial form is extremely rare (around 100 cases worldwide) and affects patients in the first or second decade of life. It is believed to be transmitted in a dominant autosomal manner with variable clinical expressivity and is manifested as hyperphosphatemia, elevated serum 1,25-dihydroxyvitamin D with juxta-articular tumorous calcifications. Moreover, the theory of a unique dental malformation serving as a screening marker for clinically non-apparent affected individuals is revisited and reconfirmed. CASE REPORT: We present a case of a Caucasian male newborn, as well as a review of the literature with differential diagnostic considerations and their therapeutical implications.


Subject(s)
Calcinosis/genetics , Calcinosis/blood , Calcinosis/pathology , Calcinosis/surgery , Calcium/blood , Hand , Humans , Infant , Male , Phosphates/blood
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