[Primary suture of older and contaminated wounds. A prospective clinical study]. / Zum primären Verschluss veralteter bzw. kontaminierter Wunden. Eine prospektive klinische Studie.

In a prospective study of 50 consecutive patients primary wound closure was examined on cases with contaminated wounds. In 42 patients the period from the injury to the attendance of the ambulance ranged from 12 to 72 hours. Eight wounds were butcher's knife lesions in professionally exposed persons. Bacterial contamination could be demonstrated in 84% of the microbiologic smears. The principles of therapy were related to the wound care directions of Kirschner 1941 including a careful debridement. Routine administration of antibiotics was not necessary. Primary wound healing was achieved in 48 cases. Sutures were removed after 10.8 days, the time off work was 6.8 days. Wound infection occurred in 2 patients. After removing sutures undisturbed healing was observed in both cases. Due to these results we no longer see a contraindication in the primary closure of contaminated wounds. With careful debridement and conscientious wound control during the first 72 hours, primary suture is of low risk, comfortable to the patients and cost saving.

[The surgical treatment concept in acute intestinal hemorrhage]. / Chirurgisches Behandlungskonzept bei akuter intestinaler Blutung.

A clinically developed and prospectively verified therapeutic concept for acute intestinal bleeding is presented in this paper. Emphasis is laid on orthograde lavage likely to enable sooner and more effective use of diagnostic means and to provide optimal conditions for surgical therapy. Prognosis can be further improved by differentiated use of therapeutic endoscopy and early elective surgery. The effectiveness of this new therapeutic concept has been successfully verified on 81 patients, between 1975 and 1986. Lethality amounted to five per cent.

[Surgical management of fresh injuries of the outer ligament of the upper ankle joint in local anesthesia]. / Die operative Versorgung frischer Aussenband-verletzungen des oberen Sprunggelenkes in Lokalanästhesie.

Fresh, isolated external ligament ruptures in adults have been surgically treated almost without exception under local anaesthesia for more than a year now at the Department of Surgery of the Rhenish-Westphalian Technical University (RWTH) at Aachen. No complications due to anaesthesia developed in these 119 patients; all of them expressed great satisfaction at this mode of surgical approach. What is more: this method is less costly and requires less personnel than surgery under peridural anaesthesia or intratracheal (intubation) anaesthesia. Hence, in the authors' opinion, isolated fresh ruptures of the outer ligaments of the ankle joint should be operated on more often under local anaesthesia than is actually being done at present.

[Apophyseal rupture of ischial bone tuberosity]. / Apophysenausrisse am Tuber ossis ischii.

The apophyses of the pelvic skeleton are the insertion zones of strong muscles and tendons and are soft points towards the end of growth. Apophyseal ruptures have quite often occurred as a consequence of overstressing in the context of certain athletic disciplines. Reported in this paper are two of the authors' own cases of apophyseal rupture of Tuber ossis ischii. Diagnosis is easy on the basis of case history, clinical manifestations, and X-ray. Treatment is conservative, with the patient hip-straightened confined to bed for three weeks. Surgery might be indicated in cases of continued seating problems or neurological failures.

["Sesamoiditis" of the metatarsophalangeal joint]. / Die "Sesamoiditis" des Grosszehengrundgelenks.

Reference is made to three of the authors' own cases and to relevant literature in an account of clinical manifestation, diagnosis, and therapy of osteochondrosis and osteomyelitis of the first metatarsal sesamoid bone. Eighty per cent of the incidence are related to the age groups between 13 and 22 years. The disease is probably based on aseptic ischaemic necrosis.

[Ligament rupture of the lateral Chopart joint]. / Der Bänderriss im lateralen Chopartgelenk.

Rupture of the dorsal calcaneo-cuboid ligament has to be expected in about five per cent of all cases of supination trauma in the ankle joint and foot. The injury can be safely verified by standardised holden radiographs, with the other side involved for comparison. Surgical treatment does not appear to be necessary. Four-week immobilisation by cast was found to be sufficient for elimination of complaints and restoration of adequate functionality.