Successful interdisciplinary radical treatment of Mycobacterium fortuitum infection in a lipotourist from Germany after abdominoplasty in Turkey.

We report a case of a 30-year-old woman who experienced recurrent infections of the abdominal wall after travelling to Turkey from Germany to undergo abdominoplasty for aesthetic reasons. The patient's Mycobacterium fortuitum infection was successfully treated by surgery and antibiotic therapy. Surgical tourism-in this case, lipotourism-is resulting in an increasing number of patients in Europe who may present uncommon disease patterns.

[Surgical therapy of cone-shaped epiphyses of the proximal interphalangeal joints in tricho-rhino-phalangeal syndrome type I: a survey among three successive generations of a single family]. / Chirurgische Therapie der Zapfenepiphysen an den proximalen Interphalangealgelenken beim Tricho-Rhino-Phalangealen Syndrom (TRPS) Typ I: Eine Familenübersicht anhand von drei Generationen.

Report on 6 individuals, occurring in three successive generations of a single family, who were affected by "classical" tricho-rhino-phalangeal syndrome type I. Besides pear-shaped noses, enlarged philtrum, hypotrichosis, premature alopecia, coned epiphysis at the proximal interphaleangeal joints with consecutive ulnar deviation of the long fingers, dysostotic feet, Perthes-like hip dysplasia with multilocated joint laxity and hyposomia were impressing. Height was 168 cm, corresponding to the 50 (th) percentile. Radiographs and 3D-reconstruction of both hands showed asymmetrical brachymetacarpia, brachymesophalangia and painful invaginations of the middle phalanx bases (type 12 according to Giedion). Angular deformities are seen predominantly in the index finger decreasing to the ring finger. Painful cone-shaped epiphyses with ulnar dislocation of the PIP joints were stabilized following resection arthrodesis with tension band osteosynthesis. At reexamination 48 months postoperatively a painfree and powerful pinch grip function of both hands was restored. All family members who showed the phenotypical features of TRPS type I revealed in genetic analysis also identical mutations. Inside the exon 4 in position 1831 there was a nonsens mutation C --> T. Non-afflicted relatives did not show this mutation.

[Interplast in India. Review of 14 years]. / Interplast en Inde. Revue de 14 ans.

Interplast teams conducted two-week (or less) camps in India over a 14 year period. The majority of the teams were mixed and consisted of German and Dutch plastic surgeons and nurses. In five different villages and cities, 1015 patients were operated: 41% concerned cleft lip and palate and 32% post-burn contractures. The work is rewarding and is considered by some the best holiday imaginable. The teams intend to continue their project in the future.

[Decubital ulcer--causes, surgical therapy and prognosis]. / Das Dekubitalulkus - Entstehung, chirurgische Therapie und Prognose -

7.6 % (n = 134/1 769) of all inpatients in Leuven, but 30.1 % of risk patients suffer of pressure sores (Norton Scale 10.4 points). Predisposed are geriatric patients or those of intensive care units. While fasciocutaneous flap likewise the superior gluteal artery perforator flap are more resistant to mechanical forces, myocutaneous flaps are the working horse for pressure sores with deep-tissue pockets or osteitis (Campbell stage > IV). Partial resection of the median sacral crest or ischiectomy are obligatory. In analyzing a 16 years period only 33 percent of myocutaneous flaps healed uneventful, while due to multiple enumerations more than 50 percent presented complications. Partial flap and complete necrosis happened in 6 respectively in 2 percent. Rectus abdominis myocutaneous flap reconstruction as well as the free tissue transfer are useful alternatives to hip disarticulation with total thigh flap coverage or a complete fillet flap of the lower extremity. Independently of the selected closure 50 percent of all decubitus patients will develop recurrences in longterm follow up. Thus prevention is of utmost importance. In Europe the costs for the hospitalisation of a patient with concomitant decubital ulcers are 2.5-times higher than for an average, non-afflicted patient.

[Dupuytren contracture in North Germany. Epidemiological study of 500 cases]. / Die Dupuytren-Kontraktur in Norddeutschland. Epidemiologische Erfassungsstudie anhand von 500 Fällen.

Dupuytren's disease is the "classical" hand illness of the north: it affects people of Celtic or Viking descent throughout the whole of northern Europe, whereas it is an unknown disease in the Mediterranean region. Dupuytren's contracture appears to be an extremity-related disease. Owing to the unclear etiology and a lack of up-to-date demographic data for northern Germany this study aims--together with the literature--to elucidate the role of associated illnesses in an attempt to discover pathogenic explanations. 566 patients suffering from Dupuytren's disease in the area around Hanover were analysed with respect to epidemiological features and their Tubiana contracture stage. 91.2% were of pure northern German stock, 12.5% had a family predisposition. The male-to-female ratio was 7:1. Men were afflicted on average at the age of 56 years. Intellectuals were scored 3.17, while manual workers scored 4.21. There were pre-existing ipsilateral lesions in 15% of cases. 55.1% had bilateral contracture. Ectopic penile and plantar fibrosis or knuckle pads were found in 6.7% of cases. The distribution of stages I-IV decreased by 2.4% from 59.1% among the 1,808 afflicted finger rays. With a score of 3.7-3.72, drinkers and smokers presented significantly more severe contractures, while the 8.2% of diabetics displayed a milder form. Among the epileptics--all of whom were affected bilaterally--the Tubiana stage of 3.71 exceeded the median manual score of 3.63 for the group as a whole. Thus Dupuytren's disease is a general but not an exclusively extremity-related sickness. The androtropy is pathognomic. Women develop the disease one decade later than men. In old age the male-to-female ratio equalizes. Drinkers, smokers and heavy manual workers present a more severe affliction, while diabetics suffer from a significantly less severe form. Although the ulnar type dominates, the radial type accounts for 14.4% of cases. 1.9 million Germans are chronically ill because of Dupuytren's disease. Despite a trauma history, Dupuytren's disease is not recognized as an occupational disease.

[Rare differential diagnosis of breast tumor. Giant cell tumor of the ribs]. / Seltene Differentialdiagnose bei einem Mammatumor. Riesenzelltumor der Rippen.

We report a case of a breast tumor. As carcinoma of the breast was suspected, a biopsy was taken and a very rare osteoclastoma originating in the rib was identified. Semimalignant bone tumors tend to recur locally. The symptoms are nonspecific; the initial diagnosis is often made late. To differentiate the diagnosis, one should think about primary and secondary bone diseases and tumors of the organs of the thorax. In our case, the tumor was completely resected, including the ribs, and the defect was covered with a corium plasty. In this way, we are able to save the breast. We discuss different methods for covering chest wall defects.

[Myocutaneous flap as reliable defect coverage in high grade pelvic decubitus ulcers. Classification, therapeutic concept and presentation of personal patient sample of 16 years]. / Myokutane Lappen als sichere Defektdeckung bei höhergradigen pelvinen Dekubitalulzera. Einteilung, Therapiekonzept und Darstellung des eigenen Krankenguts aus 16 Jahren.

Infected pelvic pressure sores of Campbell stages IV-VII require soft tissue reconstruction, which means stable, multi-layered filling cover of the defect and reliable prophylaxis of relapse. Myocutaneous flaps meet these conditions well. Depending on the extent and the area of the sore, with predilection for the sacrum, the ischial tuberosity and the femoral trochanter, the gluteus maximus, biceps femoris and tensor fasciae latae muscles are most often used for myocutaneous flaps. Primary sutures, split skin grafts or local fasciocutaneous flaps are often sufficient treatment for smaller, superficial defects. Between 1981 and 1996, 133 patients (average age 50 years) with 212 pelvic pressure sores of all stages were treated in our clinic. After radical decubitus excision with pseudotumor technique and resection of the osseous prominences, one-stage reconstruction of solitary as well as multiple defects was performed with myocutaneous flaps in 135 cases. The postoperative general complication rate for all treatments was about 10-30%. With regard to the muscle flaps, one third healed without any problems, partial flap necrosis occurred in 6% and there was total loss of flap in 2% of all myocutaneous flaps. According to present knowledge, myocutaneous flaps seem to be the most reliable method for definitive covering of deep pelvic pressure sores, independent of the cause of the ulcer.

[Use of endoscopy in plastic surgery]. / Anwendung der Endoskopie in der Plastischen Chirurgie.

Now that endoscopic techniques have been established in visceral and trauma surgery under the concept of minimal invasive surgery, plastic surgery has also begun to accept these techniques since minimal invasive surgery is very important in this field. In contrast to abdominal and thoracic surgery, plastic surgery cannot be done in preformed cavities. Therefore, it was necessary to develop new techniques and instruments. We present the most important operations in the field of plastic surgery that can so far be carried out endoscopically. The development phase is only at the beginning, and new indications are being added daily since the technical equipment can also only be gradually adapted to the needs that arise.

[Fournier gangrene: therapy with a pedicled rectus abdominis flap]. / Fournier'sche Gangrän: Therapie mit einem gestielten M.-rectus-abdominis-Lappen.

This paper describes the technique to reconstruct the genitals after an episode of Fournier's gangrene using the rectus abdominis muscle flap. A 44-year-old diabetic man felt ill with a Fournier's gangrene following inguinal herniotomia. The infection could be treated by aggressive débridement and by muscle flap coverage. Then we reconstructed the genitalia.

[Gas gangrene after cholecystectomy]. / Gasbrandinfektion nach Cholecystektomie.

We report on a case of an infection by clostridium perfringens (gas gangrene) following cholecystectomy and ERCP. Reviewing the literature, mode and risk of infection and principles of therapy are discussed.

[Solitary glomus tumors of the hand. A clinico-pathologic evaluation study]. / Solitäre Glomustumoren der Hand. Eine klinisch-pathologische Erfassungsstudie.

The incidence of recurrence following surgical treatment of solitary tumours of the hand ranges from 12% to 50%. Examination of the reports in the literature reveals that different methods of histological typing have been used and that most of the publications available are case reports or refer to studies of small numbers of patients, so that direct adequate comparison of the rates in the literature is not possible. In an attempt to find out the reasons for local recurrence of retrospective clinicopathological study was performed. All histological specimens examined within one decade were analysed. The tumours they were taken from included 46 glomus tumours (female: male ratio 28:18, age range 9-82, average 52.3 years) of different locations, 30 of them affecting the upper extremity. We had operated on 13 solitary, digitopalmar glomus tumours (8 vascular type, 3 epitheloid solit type, 1 myxoid, 1 neural) in our institution, in most cases with the aid of either a magnifying lens or an operating microscope. The mean follow-up period was 76 months, and we had no recurrences. Therefore, we conclude that regardless of the histological type, optical magnification during surgical resection of solitary glomus tumours of the hand prevents recurrences. In our opinion, early recurrences are due to incomplete excision of tumours of the types mentioned above or to misdiagnosis because of the multiple forms of glomus tumours that can occur, especially during childhood.