ABSTRACT
A stable distal radioulnar joint (DRUJ) is mandatory for the function and load transmission in the wrist and forearm. Resectional salvage procedures such as the Darrach procedure, Bowers arthroplasty, and Sauvé-Kapandji procedure include the potential risk of radioulnar instability and impingement, which can lead to pain and weakness. Soft tissue stabilizing techniques have only limited success rates in solving these problems. In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. The prostheses can be used for secondary treatment of failed ulnar head resection, but they can also achieve good results in the primary treatment of osteoarthritis of the DRUJ. Our experience consists of twenty-five patients (follow-up 30 months) with DRUJ osteoarthritis who were treated with an ulnar head prosthesis, with improvement in pain, range of motion, and grip strength. An ulnar head prosthesis should be considered as a treatment option for a painful DRUJ.
ABSTRACT
Multistructural reconstructive procedures are often required to achieve a sufficient reconstruction of the forearm and/or hand after radical tumor resection. Clear margin (R0) resection is the main therapeutic goal for the treatment of sarcomas. Plastic reconstructive procedures with the possibility of microvascular transplantations play a key role in coverage of complex defects. In our department, 20 patients with soft tissue sarcomas of the hand/forearm were treated between 1995 and 2005. Eleven patients were male, nine female. The average follow-up time was 42 months. The most common tumor type was the myxoid fibrous histiocytoma in 10 cases. Six patients received a free microvascular transplantation to cover the defect after radical resection, local flaps, or primary closure was performed in five cases. Preservation was not possible in nine cases. Ten patients received radiation and four obtained chemotherapy postoperatively (two patients received neoadjuvant chemotherapy). Extremity function, the DASH questionnaire, and patient satisfaction were our examination parameters. Our results show the necessity of plastic-surgical reconstruction of the forearm and hand as an integrative component of modern sarcoma therapy. It can be concluded that plastic-surgical reconstruction of the extremity plays a key role within the multimodal concept of therapy for patients with sarcoma at the forearm and hand.
Subject(s)
Forearm/surgery , Hand/surgery , Plastic Surgery Procedures/methods , Sarcoma/surgery , Surgical Flaps/blood supply , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy , Child , Child, Preschool , Combined Modality Therapy , Disability Evaluation , Female , Fibula/transplantation , Forearm/pathology , Hand/pathology , Histiocytoma, Malignant Fibrous/pathology , Histiocytoma, Malignant Fibrous/surgery , Humans , Infant , Limb Salvage , Male , Microsurgery/methods , Middle Aged , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Neoplasm Staging , Retrospective Studies , Sarcoma/pathology , Surveys and QuestionnairesABSTRACT
There are many techniques for cosmetic surgery of the ears and also many different procedures for postoperative treatment. The postoperative dressing is described as important for a successful outcome. We present our method of postoperative dressing in the form of liquid bonding. Cyanoacrylate tissue adhesives as liquid bonding agents are used for fixation of the pinna at the mastoid area. After 10-14 days the bonding can be easily removed. No huge dressings, tapes, or plasters are necessary. The patients are satisfied with the light dressing; they do not feel ashamed to appear in public. We have found this dressing technique to be simple and economical, especially because of the use of the bonding for skin closure before. It can be used after otoplasty with an anterior or a posterior approach.
