[Therapy of Dupuytren's contracture with collagenase - Evidence-based Consensus Statement of Austrian Surgical Societies]. / Therapie der Dupuytren'schen Kontraktur mit Kollagenase.

Dupuytren's contracture (DC) or Dupuytren's disease (DD) is a progressive fibro-proliferative disease of palmoplantar connective tissue, resulting in characteristic nodal and/or cord formation from collagen disposition. When the disease progresses, the thickening and shortening of the cords eventually leads the affected fingers to being pulled into flexion, which may be associated with marked disability, especially with bilateral disease. DD is relatively common in Europe, with the highest prevalence in Nordic countries. In Austria approx. 200 000 people are affected. The incidence increases with increasing age, with men being more often and earlier affected than women. The aetiology of DC is not completely clear, but it seems to be multifactorial; twin and familial studies confirm a genetic predisposition. The natural course of the disease can vary between relatively benign and massive progression and recurrence. In most cases, there is a fluctuating course. The DC is not curable; treatment methods range from minimally invasive to open surgical procedures. Collagenase Clostridium histolyticum (CCH) is a nonsurgical, enzymatic injection treatment for adult patients (≥ 18 years) with a palpable cord and has been approved in Europe since 2011. Clinical studies and practical experience of individual centres confirm the efficacy and safety of CCH treatment of DC. The present consensus statement was prepared under the auspices of the Austrian Society of Hand Surgery with the participation of the Austrian Society for Trauma Surgery, the Society of Orthopaedics and Orthopaedic Surgery as well as the Society for Plastic, Aesthetic and Reconstructive Surgery. On the basis of current literature and the experts' experience, it describes the various surgical procedures, with particular reference to collagenase treatment and provides guidance for their use. The statement is intended not only to illustrate the state of the art of current treatment, but also to support the achievement of uniform high quality standards in the treatment of DC in surgical centres and specialised medical practices throughout Austria.

Quality of life and body image after circumferential body lifting of the lower trunk: a prospective clinical trial.

BACKGROUND: Plastic surgery after massive weight loss remains a fast growing subspecialty. However, very few studies exist that investigate the quality of life and psychological outcome after body lift surgery. METHODS: Twenty-seven patients (25 females and 2 males) who had undergone bariatric surgery were scheduled for circumferential body lifting of the lower trunk. The patients, aged 21-58 years (mean = 39.9, SD = 10.9), underwent surgery in our department of plastic and reconstructive surgery between 2008 and 2010. All participants took part in two psychological examinations on a voluntary basis and completed the prospective pre-post study. RESULTS: Post-weight loss surgery improves the quality of life and body image. CONCLUSIONS: It is therefore an important part in the interdisciplinary treatment of the massive weight loss patient.

Scarpa fascia or rectus fascia in abdominoplasty flap elevation: a prospective clinical trial.

BACKGROUND: Postoperative seroma formation remains the most frequent complication after full abdominoplasty. This study aimed to evaluate postoperatively the formation of a minor seroma when the superficial fascia is used for preparation. METHODS: The study enrolled 50 patients who underwent a full abdominoplasty with umbilicus transposition between February 2008 and February 2010. The patients were alternated to the scarpa group or the rectus group. RESULTS: The two groups differed in terms of postoperative seroma formation and amount of average drain output. CONCLUSION: Scarpa fascia preservation seems to reduce postoperative seroma formation. The mechanism of the decreased fluid collection is not clear and needs further investigation.

Circumferential superficial fascia lift of the lower trunk: surgical technique and retrospective review of 50 cases.

BACKGROUND: The superficial fascia of the lower trunk has been described in its functional importance as a lifting layer by Lockwood in the early 1990s. Preparation more superficially is supposed to reduce the rate of seroma formation in abdominoplasty procedures. Using the superficial fascia in circumferential bodycontouring procedures of the lower trunk is assumed to combine these benefits. METHODS: Between November 2008 and April 2010, 50 patients were scheduled for circumferential superficial fascia lifting of the lower trunk at our department. Nine men and 41 women underwent a central or lower bodylifting procedure. The ultrasonically activated scalpel was used for preparation. RESULTS: Only one major complication (secondary bleeding) needing revision occurred. There were few minor complications such as seroma formation (8%) and superficial wound dehiscences <2 cm in extension (16%). No other complications occurred. CONCLUSION: The superficial fascia is an ideal layer for preparation and tissue lifting in circumferential bodycontouring of the lower trunk.

Postoperative splinting after open carpal tunnel release does not improve functional and neurological outcome.

Although surgical division of the transverse carpal ligament is the operative treatment of choice for carpal tunnel syndrome (CTS), controversy exists about the immediate postoperative treatment regimen. Splinting for up to 6 weeks after surgery is recommended by some investigators. We therefore evaluated effectiveness of splinting after open carpal tunnel surgery by a randomized, controlled trial. Fifty consecutive patients with clinically and electrophysiologically confirmed idiopathic CTS were assigned to open carpal tunnel release and randomized to receiving a light bandage (25 patients) or a bulky dressing with a volar splint (25 patients) for 2 days each. All patients were followed up at 3 months. Parameters retrieved were pain as measured using a visual analog scale, two-point discrimination, and grip strength, and nerve conduction studies. At follow-up, all patients reported definite improvement of symptoms, but there was no statistically significant difference between the two groups for any of our outcome measures. Thus, postoperative splinting after open carpal tunnel release does not yield any benefit to eventual outcome. In fact, it adds to the overall operating time and can safely be abandoned.