[Plastic surgery coverage of osteocutaneous defects of the sternum area with the vertical and transversal rectus abdominis muscle (VRAM/TRAM) flap]. / Die plastisch-chirurgische Deckung osteocutaner Defekte der Sternumregion mit dem Vertikalen und Transversalen Rectus Abdominis Muskel (VRAM/TRAM)-Lappen.

Longitudinal osteocutaneous defects of the sternal region including the caudal third were reconstructed in 15 patients during a 3-year period by using the "vertical (VRAM)- and transverse rectus abdominis muscle" (TRAM) flap. The majority of the defects resulted from chronic osteomyelitis after previous cardiothoracic surgery or were due to former therapy of breast cancer. Three VRAM/TRAM flaps were primarily transferred as free flaps with microvascular anastomosis in the axilla region. Nine out of 12 pedicled VRAM or TRAM flaps required an additional microvascular anastomosis because of imminent venous or arterial insufficiency ("supercharging"). Therefore, operative technique and operating time of the pedicled and free flap for reconstruction of longitudinal sternal defects are comparable. Adequate reconstruction and rehabilitation was achieved in 11 cases. In 2 patients revision and partial secondary defect coverage was required. Two male patients died postoperatively due to their preexisting condition.

The partial gluteus maximus musculocutaneous turnover flap. An alternative concept for simultaneous reconstruction of combined defects of the posterior perineum/sacrum and the posterior vaginal wall.

Three cases with posterior perineo-sacral defects are presented. One is a 57-year-old white female following amputation of her rectum for carcinoma, radiation and chemotherapy with a significant residual sacral/perineal defect and loss of the posterior vaginal wall. The two other patients had radical pelvic exenteration after recurrent rectum carcinoma. A new myocutaneous turnover flap as a modification of the conventional gluteus maximus flap was designed to solve the particular reconstructive problems. The flap is based on branches of the inferior gluteal artery. The posterior cutaneous femoral nerve and the motor branches of the inferior gluteal nerve not leading into the muscle portion of the flap are left intact. The skin island can be used for vaginal reconstruction or can be de-epithelialised to fill perineal cavities. This new flap eventually enabled the successful reconstruction of the posterior vaginal wall and appropriate sacral/perineal soft tissue coverage in the first case. In the other patients the flap was used to achieve closure of the deep through-and-through defect acutely in one case, and after a 3-week interval in the other.

Early wound closure and early reconstruction. Experience with a dermal substitute in a child with 60 per cent surface area burn.

A dermal substitute was used for wound management and after early scar release on a 4-year-old child with mostly full thickness burns covering 60 per cent of the body surface. The biosynthetic material (INTEGRA Artificial Skin) consists of an upper silicone film and a lower layer of porous cross-linked collagen and chondroitin-6-sulfate as a template for dermal regeneration. Eight sheets each 4 x 10 in. were used to cover the patient's whole trunk after staged tangential necrectomy. In the third and fourth weeks following application the silicone layer was easily removed and the newly formed dermis covered with widely meshed, thin split-thickness autograft. Seven weeks after admission an early neck contracture was released and the skin defect also covered with INTEGRA Artificial Skin. Following the same principle, transplantation of the thin unmeshed autograft was performed successfully 3 weeks later. The good results regarding handling, final take, apparent initial scar reduction, and early recovery may favourably effect initial treatment and reconstruction planning after extensive full-thickness burn injuries.

Hematogenous osteomyelitis of the hand skeleton in adults after dental maxillary infections.

Hematogenous ostemyelitis is infrequently seen in adults and primary involvement of the hand skeleton is extremely rare. Little has been reported about the foci of hematogenously spread infections. Two cases of hematogenous osteomyelitis of the hand originating from dental maxillary infections were reported. The first patient suffered an acute hematogenous osteomyelitis of the wrist join, spreading from dental granulomas and massive periodontitis. Despite early radical debridement, attempts to salvage the wrist joint and the extensor tendons failed, so that a wrist fusion had to be performed. The functional outcome was poor. The second patient demonstrated a chronic hematogenous osteomyelitis of the fourth and fifth metacarpals originating from chronic maxillary sinusitis. Radical debridement and use of "spare parts" of the fifth metacarpal prevented an amputation of the fourth ray. The functional outcome was excellent. These cases emphasize the importance of including an examination of the dental maxillary area when searching for a primary focus of hematogenous osteomyelitis.

[Insertion tendinopathy of the knee joint in bicycle athletes in relation to body position and shoe-pedal position]. / Insertionstendinopathie des Kniegelenkes bei Radsportlern in Abhängigkeit von der Körperposition sowie Schuhpedalenverbindung.

If a Biker complains about pain in the knee joint, one should consider the possibility of overstrain. Causes would be a wrong sitting position and a non-fitting connection between shoe and pedal. Even a minimal change of this parameters can avoid a frustrating longtime treatment.

[Combination of open osteosynthesis and external fixator in distal multi-fragment joint fractures of the radius. Methodology and results]. / Die Kombination von offener Osteosynthese und Fixateur externe bei distalen Mehrfragmentgelenksfrakturen des Radius. Methodik und Ergebnisse.

The article describes the application to a minimal open screw-osteosynthesis combined with a fixateur externe following dislocated articular multifragment fracture of the radius. No extensive uncovering of the fragments was performed. The results seen at follow-up examination in 12 patients are presented.