[Differential, oncologically adequate therapy of basalioma]. / Differenzierte, onkologisch adäquate Therapie des Basalioms.

Surgical treatment of basal cell carcinoma demands straightforward tumor management. This study investigated the radicality of surgical excision, procedures performed for defect coverage, the recurrency rate depending on the histological tumor type, among other parameters. Despite a low general incidence of 14%, sclerodermiformal BCC (morphea-like lesions) is found in 88% of all recurrencies. Based upon the results of this study, the following therapeutic guidelines are recommended: Resection with tumor-free margins must be insisted on, particularly in any exposed surfaces of the body. Histological subtyping by the pathologist is required. After initially incomplete resection in certain histological subtypes, subsequent radical resection is not mandatory. Complete resection of sclerodermiformal BCC is mandatory, and continuous follow-up of these cases is recommended.

[A surgical method of abdominal wall reconstruction in prune belly syndrome]. / Eine chirurgische Methode der Bauchdeckenkonstruktion bei "Prune Belly" Syndrom.

The "Prune Belly"-syndrome consists of a triad of anomalies: absence or hypoplastic musculature of the abdominal wall, bilateral cryptorchidism, and dilatation of the urinary tract. A surgical method of construction of the abdominal wall in such a case with a missing rectus abdominis is reported.

[Prevention using a Pseudomonas immunoglobulin in burn patients]. / Prophylaxe mit einem Pseudomonas-Immunglobulin bei Brandverletzten.

Pseudomonas aeruginosa belongs to the most frequent pathogens isolated from patients with burns. In a mouse model for artificial burns it was found that prophylactic administration of a hyperimmune globulin with antibody titres against P. aeruginosa (Fisher immunotypes 1, 2, 4 and 6) reduced mortality. Therefore, the prophylactic administration of Pseudomonas immunoglobulin was examined in a prospective randomized study in two groups of 13 patients each. Severely burned patients with at least second degree burns over 30% to 70% of the total body surface area received 250 mg Pseudomonas immunoglobulin/kg body weight by the intravenous route between days 3 and 13. After treatment, plasma IgG levels were significantly raised between days 7 and 16 as compared to the controls, yet the incidence of infections caused by P. aeruginosa was not reduced. However, only two of the six infected patients, developed septicaemia, whereas in the control group, local Pseudomonas infection led to septicaemia in five out of seven patients. The number of septicaemic Staphylococcus aureus infections was also lower in patients on immunoglobulin prophylaxis, with two cases compared to four cases in the control group. Due to the limited number of cases studied, statistically significant results could not be obtained, however, there was a positive trend in favour of Pseudomonas immunoglobulin treatment.

[Pseudomonas immunoglobulin prophylaxis in patients with burn injuries]. / Prophylaxe mit einem Pseudomonas-Immunglobulin bei Brandverletzten.

Pseudomonas aeruginosa belongs to the most frequent pathogens isolated from patients with burns. In a mouse model for artificial burns it was found that prophylactic administration of a hyperimmune globulin with antibody titres against P. aeruginosa (Fisher immunotypes 1, 2, 4 and 6) reduced mortality. Therefore, the prophylactic administration of Pseudomonas immunoglobulin was examined in a prospective randomized study in two groups of 13 patients each. Severely burned patients with at least second degree burns over 30% to 70% of the total body surface area received 250 mg Pseudomonas immunoglobulin/kg body weight by the intravenous route between days 3 and 13. After treatment, plasma IgG levels were significantly raised between days 7 and 16 as compared to the controls, yet the incidence of infections caused by P. aeruginosa was not reduced. However, only two of the six infected patients, developed septicaemia, whereas in the control group, local Pseudomonas infection led to septicaemia in five out of seven patients. The number of septicaemic Staphylococcus aureus infections was also lower in patients on immunoglobulin prophylaxis, with two cases compared to four cases in the control group. Due to the limited number of cases studied, statistically significant results could not be obtained, however, there was a positive trend in favour of Pseudomonas immunoglobulin treatment.

[Surgical treatment of decubitus ulcers]. / Zur chirurgischen Behandlung von Dekubitalulzera.

In spite of the improved quality of medical care for paraplegic patients, patients with multiple sclerosis or spinal injuries after severe trauma, the incidence of pressure sores has not diminished. Whilst superficial ulcers usually heal with conservative treatment, deep established pressure sores rarely heal satisfactorily without surgical intervention. The various surgical procedures for closure of decubitus ulcers with their classical localisation, i. e. sacral, trochanteric and ischial ulcers, are critically discussed. The myocutaneous flaps offer a wide range of choices for coverage. Sometimes, however, it may be difficult to provide a good quality myocutaneous flap at one operation. In this paper 400 patients with extensive bed sores operated upon during the last 20 years in the Clinic for Plastic Surgery in Cologne, applying the "slide-swing plasty" are reported. Some principles of the slide-swing plasty are to be respected: The flap should be tailored to the size and the shape of the skin defect. Three basic forms of the method can be applied. The flap is placed to exploit the skin reserves surrounding the defect. The flap thickness should extend as far as the muscles. The advantages of this method are as follows: Extensive bed sores can be closed. Sometimes two or three ulcers can be dealt within a single operation. Subsequent recurrences can be closed again using slide-swing plasty.

[Surgical therapy of pronounced gynecomastia]. / Chirurgische Therapie der ausgeprägten Gynäkomastie.

Surgery for gynecomastia is primarily aimed at the complete removal of the breast tissue and the reconstruction of the normal breast and chest contour while leaving minimal telltale signs of the surgery. Dufourmentel and Webster described a technique that placed the incision along the border of the nipple-areola complex. The aesthetic results are good by smaller and moderate cases of gynecomastia. The surgical correction of the larger cases requires the correction of both glandular tissue and skin. The concentric circle operation - described by Schrudde - permits the complete removal of breast tissue and corrects the skin redundancy. The periareolar operative scar is relatively inconspicuous. Our technique and the results are described.

[Reconstructive measures in burn injuries of the face and neck]. / Rekonstruktive Massnahmen bei Brandverletzungen im Gesichts- und Halsbereich.

Parts of the face and the neck are often affected by thermal damage which results in particularly disfiguring scars. Movement of the facial muscles is severely impaired and symmetry as well as contouring of the face is distorted by scarred skin which is always of lesser quality. Particular problems arise when the trauma results in partial loss of facial structures like the nose, lips or eyebrows. Plastic surgical treatment of burnt areas requires thorough knowledge of various procedures for best possible rehabilitation. Burn scars of the facial and neck region were treated by using local flaps and free skin transplantation or combination of both. The indication for the various methods is discussed and demonstrated in our cases.

[Surgical treatment of symmastia]. / Chirurgische Behandlung der Symmastie.

Symmastia means a connecting tissue between the two breasts with restricted flexibility. This disease is seldom mentioned in the literature. As therapy a slide-swing plasty is suggested.

[Correction of late burn sequelae in the area of the female breast]. / Die Korrektur von Verbrennungsspätfolgen im Bereich der weiblichen Brust.

Burn scars on the anterior or lateral wall of the thorax often disfigure the female breast. The forward projection of the mammary glands is restricted and their shape is deformed by the scar tissue. This paper presents a report of 160 female patients with deformities of the breast due to burns of the thoracic wall. In 36 patients the psychologic effects of burn scars were evaluated. The time of operative intervention of these burns in children is discussed. A new classification of the various deformities of the female breast is presented (severity-index). The results of reconstructive surgery are objectively assessed using the criterium of improvement in the severity index.

[Recontouring the lower extremity after injuries]. / Rekonturierung der unteren Extremität nach Trauma.

To achieve a re-contouring of the lower extremities the conservative methods of the local slide plasty, the Z-plasty and the slide swing plasty in combination with subcutaneously pedicled fat flaps as single or combined measures proofed satisfying. As far as the general extend and the localization of the defect admits, those measures may be superior to the free and musculo-cutaneous flaps in respect to esthetically good results. Several cases may demonstrate those possible methods. Besides the technical know-how, a well based planning in connection with a specific valuation of the different operative methods are the fundamental necessities for a satisfying result.

The use of slide-swing plasty in closing skin defects: a clinical study based on 1,308 cases.

The results of the slide-swing plasty are reviewed over a period of 16 years. A total of 1,308 patients were analyzed with regard to location and etiology. The slide-swing plasty has proved successful in practice. Its great advantage consists in the possibility of closing large defects without skin grafting. Compared to other methods, the slide-swing plasty offers additional possibilities concerning location and size. Furthermore, regional anatomic peculiarities can add to the possibilities of this procedure. Not the least interesting is the direct closing of the donor site.

[Surgical treatment of extensive cavernous hemangiomas of the face after arterial embolization]. / Chirurgische Behandlung ausgedehnter cavernöser Hämangiome im Gesichtsbereich nach arterieller Embolisation.

Six patients with voluminous cavernous hemangiomas on the face are reported. After devascularization according to the method of Djindjian the hemangiomas were removed surgically. The time interval between embolization and operation ranged from 2 to 7 days according to the hemodynamic situation of the angioma. The postoperative results are reported.

[Cavernous hemangioma of the palm with symptoms resembling carpal tunnel syndrome]. / Cavernöse Hämangiome der Hohlhand mit Symptomen gleich einem Karpaltunnel-Syndrom.

In two adults with cavernous hemangiomas occurred symptoms similar to carpal tunnel syndrome. When the angiomas were removed the pains as well hypaesthesia and hypoalgesia in the median nerve area disappeared completely. While in one patient this result stayed on, in the other the same symptoms reappeared when hemangioma recurred. Ischemia in the median nerve area is supposed to be due to shunts in the hemangioma. Their existence could be noticed angiographically as well as histologically in operation specimens.

[Burn scars of the face and their treatment potential]. / Verbrennungsnarben des Gesichtes und ihre Behandlungsmöglichkeit.

Hypertrophic scars and contractures are the result of the contraction of healing burns, giving a rigid mask-like, expressionless appearance of the face. Skin replacement should be done in stages, successively in the various regional entities of the face. The treatment of the burn-scarred skin of the face includes various methods of pedicles flaps, splitt- and full-thickness grafts, hair-bearing grafts to restore eyebrow etc. These alternatives are shown in this paper and illustrated by case reports from our clinic.

[Late complications in breast construction with silicone implants]. / Spätkomplikationen bei Mammaaufbau durch Silikonimplantate.

Of 187 patients with silicone breast implants 14% developed a capsular formation as late complication needing surgical therapy. Apparently neither the volume and type of prosthesis nor the operative proceeding had any influence on the formation of a constrictive capsule. No significant difference between augmentation plasty by hypo- and aplasia respectively and breast reconstruction after subcutaneous or radical mastectomy could be noticed. There has been no explanation for unilateral hypertrophic capsule formation after simultaneously performed bilateral prosthesis implantation. Compared with other authors we had a smaller incidence of the IIIrd and IVth stage capsular formation. This is caused by: 1. The advantage of a two-stage proceeding over the simultaneous one after subcutaneous mastectomy or subsequently to reconstruction by a flap plasty after radical mastectomy. 2. Systematic drainage of the bed of the prosthesis to avoid any hematoma or big liquid accumulations. Diffusion of silicone in the tissues by spontaneous rupture of the prosthesis as further late complication is discussed in 2 cases.

[Plastic operations in facial paralysis]. / Ersatzoperationen bei Facialisparese.

From 1972 to 1977 we operated on 40 patients with complete or incomplete facial palsy. There were only such cases in which a spontaneous or operative reinnervation could not be expected. Anamneses between appearance of the facial palsy and its operation was 11,8 years on an average. Different substitute operations for aesthetic and functional improvement were applied. Only a combination of different operation methods leaded to a satisfying result.

[Dominantly inherited bilateral ear anomalies (author's transl)]. / Beidseitige symmetrische Ohrmuschelmissbildung mit dominanten Erbgang.

A family, in which 12 patients through 5 generations had bilateral symmetrical anomalies of the external ears is reported. Assessment of the pedigree shows an autosomal dominant inheritance.

[The Schrudde method of plastic surgery. Results after 15 years use of the method]. / Die Schrudde-Plastik. Auswertung von Ergebnissen nach 15jähriger Anwendung der Methode.

After 15 years of experience with Schrudde's slide-swing operation, the results of this method are evaluated. Indication has been examined in 911 cases, both as to localisation and etiology. Since the resulting scars are smaller than the circumference of the defect, this approach possesses considerable advantages over other methods. Its safety enables it to be applied where defects are very extensive. A first attempt is here made to analyse the method geometrically.